Monday, 19 July 2010

Perspectives on Lansley's NHS reforms

Daniel Hannan writes:

Andy Burnham, the Labour leadership contender, says that “Daniel Hannan could easily have written” the Coalition’s health policy.

Er, no, Andy. Why don’t you take a look at the health policy that I in fact have written? It comes in a book called The Plan, and it’s based on Singapore-style transferrable healthcare accounts. On every metric, Singaporeans are healthier than we are. They live longer, their waiting times are lower, their chances of recovery from the moment of diagnosis are better. But here’s the thing: Singapore spends less than half of what we do, as a percentage of GDP, on healthcare. If we spent the same amount as now, but gave people the freedom of choice that Singaporeans have, it seems not unreasonable to suppose that our results would improve commensurately.

Incidentally, in Singapore, as in every developed country, the state pays for those who cannot afford their own healthcare. This point is worth stressing, Andy, since you often give the impression that free treatment for the poor is a unique property of the NHS. In fact, low-income Singaporeans do better than low-income Britons, partly because their government is concentrating on them instead of trying to run a monopolistic service for everybody, and partly because they benefit, like everyone else, from the upward pressure on standards caused by competition among providers.

Earlier today, I read two other interesting articles on NHS reform. James Bartholomew considered the Swiss model:
Switzerland has arguably the most successful system of healthcare in the Western world. It is an insurance system with a twist. You are obliged to take out health insurance but you can choose which company to use. There is no state monopoly. So you can choose an insurance group which is connected to your line of work. Or you could go with a trade union-run insurance cooperative. Or a private, commercial company. That means there is some competition among these companies to provide the best possible service for the lowest possible price. Then these companies, in turn, have some choice over which doctors and hospitals they commission to work for them. So again, the doctors and hospitals have to compete to offer the best facilities and treatment at the lowest possible cost. The pressure is on and the performance is one of the best in the world. Poorer people get credits which enable them, too, to choose insurance.

The Swiss health service is decidedly superior to that in Britain, too. It has more doctors per capita, more advanced scanners, better cancer outcomes and so on and on.
There was also an excellent article over at Conservative Home:
No one in healthcare should have their professionalism and integrity undermined by one-size-fits-all politically-decreed pay scales. Nor should remuneration be imposed and held back at regional levels. To properly value doctors, nurses and other health workers, remuneration must be set at proper commercial levels and this will only happen in a more open, dynamic and responsive market.

Employment contracts should be a matter for each independent employer and their staff – not the government or any of its ‘appointees’. Indeed, it is in this context that trade unions should proactively push for, and embrace, this new world of welcome opportunity. Gone will be the tedious days of top-down state direction, beer and sandwiches at number ten, and endless, counter-productive, national strikes.

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