NHS bad, Bismarck good
There was profound pessimism about Westminster-style NHS healthcare systems on display at the European Healthcare Policy Group (EHPG). And even more pessimism about integrated healthcare, the latest buzzword from NHS England.
In an afternoon that looked at what the EHPG, a loose bunch of academics and policymakers, felt they had learnt over 21 years, several messages became clear.
The first was the profound pessimism of those who study NHS systems in partisan, first-past-the-post Westminster-style systems, such as Canada and the UK. The second, was that just giving public sector entities more resources doesn’t lead to more and better output.
On these grounds, alone there was pessimism about the new integrated care model in the UK. “It will simply create 48 monopolies. Everything will get worse,” claimed Prof Julian Le Grand, who advised Prime Minister Blair to adopt a successful “terror and targets” approach which saw big jumps in performance up to 2010.
Societies where there are more consensus politics, such as the Nordics, do better with NHS systems, although the risk is that such systems always remain a bargain struck between central government and the medical profession.
Bismarkian systems do better. The French have controlled hospital costs through centralisation, whilst the Dutch have through insurer-led market competition and consensus. And neither, these days, are much more expensive than the British system. France in 2019 spent 11.1% of GDP on healthcare according to the OECD, with the Dutch and the British level at 10.2%. But that includes long-term care where the Dutch spent 4% of GDP, nearly twice as much as the UK, at just 2.4%. Who said Bismarckian systems are always expensive?
A big question is how do you get health care systems to innovate. The EHPGers generally bemoaned the way institutional entrepreneurs get no rewards. But, this week, Dr Axel Heitmueller, a visiting professor at Imperial College London’s Institute of Global Health Innovation suggests less central control would enable innovation in the English NHS. We’d disagree. Innovation will come increasingly from for-profit providers who have a much clearer set of goals around efficiency to create profits. It is much harder for innovation to spread effectively in NHS systems.
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.
