Healthcare Reform in NHS - Is Competition Always Bad?
Choosing sides
There are two schools of thought currently in the UK:
- Competition always raises standards and lowers costs.
- Competition against public services breaks their ability to provide top quality services.
Both are right, and both are wrong.
History suggests that in a fair market, competition improves quality and reduces prices. The real difficulty is that the marketplace, healthcare, isn't a fair.
Over the last 10 years, under Tony Blair as prime minister, and perhaps the previous 10 years under Margaret Thatcher, public sector healthcare has faced competition from private companies. Quality has improved, and the position of the patient, central to healthcare, has definitely improved.
Bad behaviors have also been exposed; for-profit companies selectively pick the easy and uncomplicated operations, and make a healthy profit; but they leave publicly funded healthcare unable to provide the more complicated operations, at any price.
Healthcare reform in USA
Mark Britnell (formerly a senior officer in the Department of Health, and now the healthcare president for KPMG) has exposed the current ConDem(n) government policy by rubbing his hands together in glee and telling US healthcare providers that there is lots of money to be made in the UK (he's right, the way the policy is written).
He quotes from two main reports – one (WHO National Healthcare System Rankings 2000 (World Health Organistion)), and the other published last year by the Commonwealth fund. Both havethe same message – that the US system that Mark Britnell is holding up as a paragon of virtue, costs vastly more, and delivers vastly worse results. For example, the Commonwealth fund report (newer - using 2007 figures) actually says that UK is the most efficient, delivers excellent outcomes, and for healthcare in a developed country, is the second cheapest ($2,992 in 2007 USD vs New Zealand (the cheapest) at $2,454, and USA at an eye-watering $7,290). The table of Commonwealth Fund results is available at MM2010s.gif. This is surely a case of letting vested interest outweigh the evidence. My own findings can be found at healthcare_management
NHS "saving money" may actually cost more
In the face of this evidence, it may not always be wise to imitate our "special relationship" across the water. A detailed study was done in 2003 (Porter & Teisberg) comparing medical outcomes and costs between different US states – effectively, comparing health systems when all other things are equal. It showed clearly that a GP-based system is better and lower cost – to quite a dramatic extent. In fact these authors specifically state that what the US needs is a healthcare system "like the UK".
I've explored competition in some detail: see choice and competition in the NHS, is competition right for the NHS and how do you ensure quality healthcare?.
I have a lot of experience in the NHS, as a manager in a GP surgery, in the community and voluntary sector (CVS), and preparing integrated systems for health and care. I've taken care to check my figures with original sources, and everything points to the fact that the UK NHS is pretty good. Even taking a simple measure such as longevity (life expectancy at birth), where UK appears to trail Japan (the leader) by years, only last year Japan discovered that around one third of people claiming pensions (and therefore some of the oldest people in the world) had been dead for more than 10 years (yes really! Still claiming their pension though)!!
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