Food for thought

~ for the Future

The current malaise in the NHS is dragging patients down.

They say they are fed up with nurses and doctors looking grey, over-worked and dispirited.

• And even more fed up with longer waiting times,
• being told the post-code lottery means they don’t get a drug,
• or shuffled laboriously through the system to get what should be simple tests.

It is OUR NHS – isn’t it about time we said “enough is enough”?

Brave Soul

Dr Kailash Chand, a GP in the north of England, has started a government email petition.   If he gets 100,000 signatures, this automatically  forces a debate in Parliament on the Health and Social Care Bill.

No doubt his bosses won’t be pleased with him (the Dept. of Health doesn’t like those who speak up), but if you want to support him click through to

https://submissions.epetitions.direct.gov.uk/petitions/22670

What else?

It is time to challenge the myth/mantra repeated time and again by NHS staff – French care may be better but it is more expensive.

When you compare like for like (i.e. if you take out of the equation all the private rooms, home care, massages etc. the French receive ) and work out who pays what – the French and ourselves are paying pretty much the same.

Perhaps we could go back to a report, written in 2008, for the think tank Reform.  What Prof.Nick Bosanquet, Andrew Haldenby, Laura Hurley, Flavia Jolly, Helen Rainbow and Prof. Karol Sikora wrote is worth re-reading, as a basis for patients to challenge just what is the NHS and La La doing with OUR  money?

The typical UK patient  pays around £2,250 per individual per year, so that everyone is covered by the National Health Service.

So the thoughtful report should be required reading for Cameron and Lansley;  instead of repeating “European healthcare is better”, and leave it at that – perhaps instead of devising all his time and money wasting plans, Lansley would take on board what the Reform Report says – and ACT on it.

So why change?
Over many years, Reform says academic studies have pointed to a gap in performance between the UK and other countries.

Health outcomes are difficult to measure, but the UK delivers a poor level of social equity despite having universal provision.  Other countries have systems that rely on part tax funding – part personal insurance funding for health care.

International options point to two key conclusions:

1.    Drawbacks of voluntary coverage concern both effectiveness – due to the problems of adverse selection – and equity. The only major developed country which operates voluntary health insurance is the USA, and that country is itself divided as to the wisdom of the policy. The NHS does provide cover to every UK citizen (although not for every condition), and that is a valuable strength.
2.    In recent years new insurance-based systems, in particular the Netherlands, have been created. Systems with strong insurance characteristics, such as France, Germany and Switzerland, are reforming in order to manage demand and continue to deliver a better standard of healthcare than the UK. The UK looks out of line with global developments.
The Prime Minister claimed that the NHS was “the best insurance system in the world” because, in systems with greater insurance elements, the costs of healthcare could bankrupt families on normal incomes.

Reform says people living in countries such as France, Germany, Switzerland or the Netherlands have the same kind of protection as the Prime Minister described, including cover against the very high costs of catastrophic illness. The task for the NHS is to combine its universal base with the focus on the patient evident in other countries.

Insurance incentives have the following advantages:

> they provide reasons for individuals and authorities to value the long term;
> they achieve greater value;
> they incentivise individuals to participate in their own healthcare;
> they remove unequal access to treatment; and
> they de-politicise healthcare.
Insurance-based systems are closely focused on individual patient outcomes as healthy patients cost less. This means a focus both on general well-being and on ensuring customers that do become ill recover in the shortest period of time.
In other words, an insurance-based health system encourages preventative medicine – something sadly lacking in the NHS.

Ending the postcode lottery
In insurance based systems patient entitlement is defined, and patients are aware of what drugs and treatments they have access to. This empowers patients and makes the system inherently patient centred, and would overcome the current difficulties in the NHS where some patients in one area have access to treatment while other do not.
The key elements of insurance success
We have seen the advantages of insurance incentives. However, there are a number of crucial elements that are required to make an insurance system work.

Firstly, it is important that a sufficient range of providers are able to operate in the market. Secondly, the core system of compulsory insurance needs to cover the vast majority of health problems to ensure that it is for only a minority of conditions that people are buying healthcare for through self-payment or supplementary insurance. Thirdly, people have to be incentivised to prevent abuse of the system. Finally, information and capability to use that information must be present.

Incentives to stop abuse of the system
People may have an incentive to abuse an over-generous system of provision.

In 2004 the average French GP prescribed drugs worth €260,000 a year and the French used three times as many antibiotics as the Germans.  The French have tried to tackle this problem of overtreatment by requiring co-payments for many drugs and GP visits.

One academic has estimated that between 20 and 30 per cent of healthcare funds in America go toward unnecessary treatments which can in fact have a detrimental effect on public health.

UK families already spend £1,600 per year on healthcare
Reform research shows that the average household invests significant amounts privately on their own health. At a conservative estimate the average household is spending £1,200 a year privately on core areas of healthcare, including private hospital treatment, dentistry, optometry and over the counter medicines.

Alongside this spending individuals are also spending a considerable amount a year on improving their own lifestyles through diet and exercise.The average family spends around £400 annually on areas such as gym and sports club membership as well as complementary therapies.

The basic healthcare package in France, which includes the cost of social security contributions and the cost of a basic supplementary insurance, is £2,021.46.

This is a comprehensive package which covers the cost of consultations, pharmacy, dental costs, surgical costs, hospital stay and ambulatory transport amongst others. Furthermore, the French state currently guarantees patients access to all cancer treatments, including experimental ones.

The option to top up for luxury services or rare drugs
Supplementary insurance would cover a wider range of health treatment and pharmaceuticals that are not available in the core package. Supplementary insurance could be purchased for an additional charge from the Health Protection Providers.

Based on supplementary insurance in other countries, examples of cover might include:
> Additional surgery e.g. additional eye surgery during a cataract operation to alleviate the need to wear glasses.
> Drugs not available in the core package.
> A higher standard of hospital accommodation, such as a private room.

Competition
An essential element of a system that acts as an insurer is competition. Competition drives efficiency and quality of services for patients.   However, competition has to be on a level playing field, and signs are that current plans for commissioning services won’t take into account all the factors.

Role of government
Now, this is where it gets interesting.  I can never understand how a politician, with no training whatsoever, can suddenly find themselves managing a health budget of billions.  No company would run this way.  Yet the NHS expects a rookie Minister to know how to commission health services.

Reform suggests the role of the Government would be considerably reduced.

It would have a regulatory function to ensure that all Health Protection Providers and service providers were of sufficient quality. Further tasks would include allocating contracts for emergency services and deciding the budget of the service on a five year cycle. The reduction of this role would eliminate the need for regional agencies i.e. Strategic Health Authorities.

This would depoliticise the running of the health service, and remove it from the political cycle.

The authors
Nick Bosanquet is Professor of Health Policy at Imperial College London and Consultant Director of Reform.
Andrew Haldenby is Reform’s Director.
Laura Hurley was an intern at Reform during the summer of 2008.
Flavia Jolly was an intern at Reform during the summer of 2008.
Helen Rainbow is Reform’s Senior Researcher specialising in health.
Professor Karol Sikora is Medical Director of CancerPartnersUK and a consultant in cancer medicine.

Report costs:  £20.00
Reform, 45 Great Peter Street, London, SW1P 3LT
T 020 7799 6699
info@reform.co.uk
www.reform.co.uk
ISBN number: 978-1-905730-12-4