The UK Government should look to overseas health services to develop a new healthcare funding model, says Tim Baker
The interim Wanless report and the state of the NHS has put healthcare back at the top of the news agenda, and it is likely to stay there. Progress towards meeting consumer expectations will be a significant factor in determining the outcome of the next general election.
The NHS is an enigma in may ways ' brilliant at providing life-saving medicine for some, while failing others who suffer endless waits and may even die without ever receiving treatment. Despite this, consumers continue to support the NHS ' but why?
Most people do not care who owns the hospitals or employs the doctors, nor whether their care is delivered privately or publicly. They want the most appropriate care delivered in modern and comfortable surroundings.
The Government was late in recognising this ' indeed it is difficult to know even now whether they have. Some of the rhetoric and, indeed, some of the policies have changed. Maybe 2002 will see a DTC being run by the private sector, but progress seems slow and erratic. Private sector providers need greater certainty and Government commitment. They do not need signed NHS contracts, but they do need to know they will be able to compete for such contracts on a level playing field.
So if consumers are happy to have their care delivered privately or publicly, what about paying for it? The interim Wanless report dismisses all options bar taxation. This in itself is odd since the terms of reference for the report are focused on future costs of healthcare, rather than methods of financing. The Government says it wants a debate on funding, but as far as it is concerned, taxation is the only option. But why have a debate if your mind is already made up? The inevitable conclusion is that much of this has more to do with policy than with the actual needs of the public.
All of which is a shame. In fact, shame is too soft a word for something that for some is quite literally a life or death issue.
There are powerful lessons to be learnt from overseas. Social insurance would enable the fundamental elements of the NHS to be retained, available to all and largely free at point of use. No single model of social insurance is likely to be an exact fit for the UK, but we have a unique opportunity to take the best bits of all models and the NHS. A recent report from the National Economic Research Associates ' Towards Stakeholder Healthcare ' demonstrated how this could be achieved.
So where does this leave the private funding sector? In the short term little is likely to change. However, we must take this opportunity to pursue a change of agenda with Government and policy makers. The social insurance model represents the best of these opportunities as it preserves the essence of the NHS while giving consumers more choice and opportunity to top up basic packages of care. Meanwhile healthcare consumers, both corporate and individual, will be forced to make difficult choices. Do they continue to rely on a public service that often does not deliver, or do they choose to pay twice and go private? As in the last few years we are optimistic that increasing numbers of consumers will choose the private route.
