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How to ‘save our NHS’ – look to what works better elsewhere…

Via the Adam Smith Institute, I came across the Euro-Canada Health Consumer Index 2010 report (PDF), which ranks a number of European healthcare systems in terms of their ‘consumer friendliness’:

The healthcare systems of Europe can be classified into two distinct models: the Bismarck model and the Beveridge model. Bismarck systems have been described as a “social insurance” model. In these systems, there are multiple different insurance organizations that exist and compete with one another. These insurers are organizationally independent of the healthcare providers in the country. Under the Beveridge model, the financing and provision of healthcare are handled with-in one organizational system. Financing bodies and providers are either wholly or partially contained within a single organization. Britain’s National Health Service, the Nordic countries’ medical systems and Canada’s Medicare system are all examples of the Beveridge model.

Throughout the history of the ECHCI, healthcare systems based on the Bismarck model have been shown to outperform the Beveridge systems. The larger Beveridge systems—Canada, Italy and Great Britain—have consistently been ranked near or below the middle of the indexes. These results strongly suggest that the separation of insurers from providers and the provision of consumer choice are important principles for the development of high-performing healthcare systems—especially in medium- and large-sized countries.

The top-line results of the 2010 index were as follows (p14):

Despite all of the additional billions of pounds that has been sunk into the NHS over the past decade, in terms of the customer perspective the UK resides only 17th in the list of nations compared; indeed of the ‘big’ EU countries only Spain falls below us.

Is it worth pointing out that Netherlands (#1), Germany (#2), France (#4), Switzerland (#5); Austria (#6); Luxembourg (#8) and Belgium (#10) – i.e. 7 out of the top 10 – all have ‘Bismarck’-type healthcare systems?

While I agree with those people who are loudly proclaiming that we need to ‘save our NHS‘, based on the results above I would strongly suggest that they may well be looking in completely the wrong place for the solution…

UPDATE: Dr Michael Fitzpatrick asks “Save our National Health Service? Why, exactly?” over at Spiked:

I have generally found it a useful rule of thumb in medical politics to assume that if the British Medical Association (BMA) opposes something (like the NHS in its first decade), then there must be something good about it. If, on the other hand, the BMA has decided to campaign for something (like coercive measures against smokers and drinkers), then it is unlikely to be worth supporting. Now that the BMA has come out against the Lib-Con reforms, I have to look again to see if I have overlooked some progressive content.


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