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Why can’t the NHS be run like Tesco?

Came across an excellent post from the Adam Smith Institute the other day that’s definitely worth sharing:

We’re lucky there’s no such thing as the National Food Service [NFS], modelled on the National Health Service, to ensure equal access to affordable food supplies.

[…] It’s not hard to imagine the disaster befalling our kitchens and restaurants if the industry was organised into an NFS in pursuit of an equality agenda. GPs (Grocery Practitioners) would be the gatekeepers to food supplies, assessing everyone’s basic dietary requirements and issuing coupons according to guidelines from Whitehall under budgets set by the Treasury. PCTs (Primary Comestible Trusts) would oversee the distribution of food parcels, adopting best practices as judged by NICE (National Institute for Cuisine Excellence). There’d be nationally set waiting-list targets to see consultants on wine and cheese.

Fortunately, nobody is seriously proposing a National Food Service – yet. But, equally, nobody is seeking lessons from the supermarkets on delivering efficient health care in rapid response to changing consumer demands. Which is too bad.

I think this article makes its central point very clearly: that there is absolutely no credible reason why the NHS needs to be organised the way it is, i.e. through central government dictat and controlled by all-powerful vested interests. The equally important grocery industry is as near to free-market capitalism as you can get in this country, and yet somehow the less well off have plenty of options on where to shop and have not starved en masse.

The time for a free-market health service that truly reflects the needs of the customer – not the producers – is now. Will anyone do anything to bring this about before the current system collapses under its ever-increasing burden…?

I’m not holding my breath…

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A tale of two drugs: why we all pay (more) for socialised care

I came across a really interesting article on the US healthcare system on the Mises Institute website yesterday, which puts forward the argument that rather than help, Government intervention in the healthcare market only makes things worse – most obviously by raising prices and costs way higher than they otherwise would be. Quite frankly, this article is completely relevant to the UK’s NHS as well.

Below is a key section of the article where the author uses a simple example to demonstrate the inherent flaw in socialised systems:

The following is an example of a real and very popular drug that I use on a routine basis that I will call drug X. Drug X works by inhibiting blood clot formation (when a blood clot forms in a vessel in the heart, one can have a heart attack). Drug X and drug Y work together by acting on different substrates of the clot-formation process to ultimately effect the same outcome — stopping clots from forming. Drug X costs on average $141.82 per month. Drug Y costs a couple of dollars per month over the counter at your local drug store. What does the data tell us about the two?

Multiple studies have been performed to answer the question: Does drug X improve cardiovascular outcomes compared to drug Y alone after a patient has had a major cardiovascular event or a stroke? The answer, unequivocally, is yes. By how much? The answer is a few percentage points, give or take.[2] Does it eliminate the risk all together? The answer, unequivocally, is no. It should also be noted that drug X in addition to drug Y confers a minor increase in the risk of having a major bleeding event. So the question is: How many people, in the appropriate clinical setting, knowing this information, would buy drug X for $140 per month? Probably not nearly as many who take it now for nothing or for a small copay. Leaving aside the issue of brand names and patents, under conditions of market competition, do you think the company who makes drug X would lower the price to entice more buyers? If they did not lower the price, or simply could not lower the price due to production costs, I would venture to guess that drug X would not be marketable outside of a small niche of patients.

Now ask yourself, is the doctor who recommends drug X the bad guy? Of course not: drug X does provide a benefit beyond drug Y itself, and furthermore, if he didn’t offer it and the patient had a heart attack (which could happen despite being on drug X) the doctor could be at risk of losing his medical license. After all, drug X is part of the standard of care. Is the patient the bad guy? Of course not: if you were offered the chance to take a drug that had a defined benefit and wouldn’t cost you that much, you’d be silly to reject it. Is the pharmaceutical company the bad guy? No, they have a responsibility to their shareholders to make a profit, so they should sell their product at the highest price possible.

So who’s to blame? The answer: a system that has been developed by government intervention to interfere with consumer sovereignty and make every individual pay for every other individual’s medical expenses so that the individual consuming the care does not bear the full price at the point of utilization.

For me, this is pretty much self-evident. Amongst all of the wailing and gnashing of teeth that we have all been subjected to recently on the subject of reform – from the unions, the myriad vested interests, the politicians (from all parties) and our unbiased (hah!) media – where is the voice of the actual, put-upon consumer?

Stop tinkering with the NHS – it needs a complete overhaul

It seems that I have a new addition to my ‘Do Not Read!!’ list of London Evening Standard commentators: Andrew Neather. The article from Neather that caught my eye on the train home yesterday evening was “I’ve seen the real cost of tinkering with the NHS

Neather begins his piece by trotting out the age-old red herring used by those who defend the current NHS setup – conflating the system with some of the people who work in it:

Down in the West Country for an aunt’s funeral, I was struck afresh by the oddness of people’s attitude to the health service. By the time my mother’s kid sister went to the doctor, it was far too late to treat her cancer. But for the remaining couple of months of her life, she received excellent care. “The nurses were so good,” said my mother.

And while, for sure, we read some healthcare horror stories in a nation of 60million, most of us say the same thing. In opinion polls, people consistently tend to rate their own care highly – especially their GP. But ask them what state they think the NHS is in, and half or more tell pollsters that it’s a basket case.

So your mother had a great nurse. How is that of any relevance at all to how the NHS is run? Presumably said nurse would continue to be a great nurse whether she worked in a state-run or a private hospital? It’s the same story with our GPs – in terms of the overall NHS system, we as customers at least retain some degree of control over whom we go and see in primary care. If we do not like our allocated GP, then we can usually ask to see a different one in future. Unfortunately, once we need specialist consultation and care, those of us needing NHS care pretty much have to take what we are given.

[Cameron] feels the need to do so because while the planned changes are complex, most people instinctively realise that NHS privatisation – companies profiting directly from their illness – is a scary thing. And they haven’t even lived in the US, as I have, and seen how rubbish such healthcare is in practice for all but those with gold-plated insurance policies.

Neather demonstrates his complete lack of understanding of economics here (although to be fair, none of our politicians apparently has a clue either). In a completely free market, i.e. with unfettered competition with no state interference in the form of barriers to new entrants, and with no regulations and tariffs favouring vested interests, profit is the deserved reward for entrepreneurs risking their own capital to provide goods and services to society. There is NOTHING wrong with profit – in healthcare as in any other industry – if it comes from voluntary transactions that benefit both parties.

Neather also throws in the obligatory red herring of the comparison to the US healthcare industry, as the bogey man to scare away people from even thinking about NHS reform. Of course the US is not the gold standard that we should be trying to emulate! As I wrote about previously, there are numerous other national healthcare systems with much better outcomes that we should be looking at for inspiration.

As a friend who is a head of service in mental health asks: “What if a private sector provider goes out of business -what happens to their patients? A decommissioned NHS service will not be there waiting.”

In a truly free healthcare market, there would be a multitude of private sector providers all competing for your business. If one provider went out of business (presumably due to incompetence or losing customers due to poor service), then there would be many others who could step in and would gladly take you on. If Ford went bust, would we suddenly not be able to buy a car? Would your lights go out at home if your electricity provider went into administration? Is Apple an international pariah because it makes stupendous profits from the sale of its highly desirable products? Of course not!

It would be perfectly possible to construct a fully privatised healthcare service in the UK, that would remain free at the point of use, and which would still provide cover for those who genuinely could not support themselves (e.g. the elderly & infirm, the mentally ill, etc). The problem is – and this is why I doubt that I will ever see it happen – that to create such a system would necessarily entail the dismantling of a system which serves the needs of the providers, rather than us the customers.

Perhaps the saddest thing about all this is that useful idiots like Neather don’t realise just how effectively they are being used by the same vested interests that perpetuate the NHS ‘basket case’ we all know is there…

Manu elsewhere…

Posted on my employer’s blog: What should healthcare comms agencies learn from Lady Gaga?

Lady Gaga is successful because she is unique – she is doing things which we have not seen before in the music scene. For me, the lesson for healthcare comms agencies (or any business for that matter) is clear – it’s not enough to be excellent at what you do, to be truly successful you need to stand out in the crowd.

Categories: healthcare

Can the NHS ever be fixed before it inevitably collapses?

A cartoon posted over at Guido’s place caught my eye this morning – while amusing it is also depressingly apt:

Despite the UK having a coalition government, with both parties involved having promised in their election materials to reform the NHS so that it finally serves the customer, it looks like nothing will happen. What’s particularly frustrating is the fact that I was naive enough to believe that anything (even these confused, compromised reforms) would actually happen.

A good summary of the major reason for this can be found over at The Commentator:

As things stand, the NHS isn’t far off needing intensive care all of its own. There is nothing healthy about a shoddy monopoly being sustained by borrowing. Despite being the third largest employer in the world — behind only the Chinese Army and Indian Railways — the NHS places only 25 percent of its staff in any meaningful front-line role.

The trouble is that though horror stories emerge all the time about the appalling service received, overall the NHS is supported by the public with a quasi-religious fervour. Any perceived criticism, even from those who want to protect the principle and practice of healthcare that is free-at-the-point-of-use, is simply shouted down.

On the back of this public support, the NHS’s back-end bureaucracy and managerial rump, facing the axe, have whipped up enough scare stories about the reforms to begin to turn the battle regardless of the true interests of the organisation they profess to care about.

Unfortunately, the vast majority of people in the UK clearly get taken in by this propaganda – result: the vested interests in the industry will win the day once again, and we shall continue on our merry way to complete system failure.

Something needs to change, fast. Just don’t hold your breath that it will do so any time soon…

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

2011-04-06 1 comment

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.

A health story to smile about… :-)

Here’s a healthcare-related story to smile about:

Researchers at Osaka University in Japan set out to determine whether music and laughter interventions would reduce blood pressure in one of two situations: immediately after listening to music or laughing and after three months of one-hour interventions that took place once every two weeks.

The scientists signed up 79 people between 40 and 74, who were randomly assigned to one of three groups. Thirty-two listened to music, 30 were assigned to a laughter group, and 17 neither listened to music nor participated in laughter sessions.

After three months, researchers say blood pressure significantly decreased, by nearly 6 mmHg, among those who listened to music. It decreased by 5 mmHg among those who took part in sessions designed to make them laugh.

When put in the context of ~10 mmHg blood pressure reductions observed with pharmaceutical monotherapies, shouldn’t we perhaps be prescribing music and laughter for those with mild to moderate hypertension?

Including these ‘therapies’ would at least make new Phase III hypertension clinical trials more fun wouldn’t they…? 😉

Categories: healthcare, science