"A refreshing addition to the world of think-tanks" Daily Telegraph, 18/10/2007

HEALTH

Last updated: 29/07/2008

The NHS as a model is deeply flawed and a change to a more effective system is required.

Many myths have been developed around the NHS since its founding in 1948 an unfortunately few are based in reality.  A common myth is that the NHS is the “envy of the world” and that the NHS is “one of Britain’s greatest accomplishments”.  Nothing could be further from the truth.  Apart from a number of socialist ideologues, the NHS is envied by few outside Britain and if having one of the poorest performing health systems in the developed world is a great British achievement, Britain would be in a poor state.

A recent report published in the Lancet, showed that Britain has one of the worst five-year cancer survival rates in Europe and certainly well behind the best in the study, the United States.  England has a female cancer survival rate of only 52.7 per cent, compared with 62.9 per cent for the United States or 61.8 per cent for Iceland.  Britain performed poorer than former communist countries such as Slovenia, not to mention Spain and Malta.  For males, a similar story is told, with England having a survival rate of only 44.8 per cent compared with the United States at 66.3 per cent.  Again, below Spain, Ireland and Italy.

Around the same time another report on strokes appeared in the British Medical Journal that reported that Britain had some of the poorest stroke treatment rates in Europe.

Before addressing the problem posed by Britain’s health system, the first step is to acknowledge the problem.  Like an alcoholic, Britain’s road to recovering a decent health system begins with admitting the truth. It is simply not good enough for senior political leaders to perpetuate a lie simply for lack of political courage.  All parties are equally guilty and show themselves as only too willing to take political advantage in attacking anyone discussing alternatives to the NHS as “Americanising the NHS”.  Politicians who seek political advantage in such an important policy area must bare responsibility for the many thousands of Britons who needlessly die each year due to a system not fit for purpose.

Having identified the failure of the NHS to deliver a 21^st Century health system for Britain, we must turn to the alternative.  Looking at many statistics, including the aforementioned cancer survival rates, it may be tempting to look at the US private insurance system as a solution.  Setting aside the myth that the US government doesn’t look after the poorest in society (the US government spends more per capita on healthcare than any major European government apart from Germany), the sheer cost of US healthcare at 16 per cent of GDP demonstrates why Britain cannot go down that particular path. 

In recent years there have been calls by members of both the Conservative and Liberal Democrat parties for a move towards a continental social insurance model.  Undoubtedly these offer a better solution to the NHS, but not significantly better given the extra expenditure enjoyed by these systems.   Defenders of the NHS will also claim that this increased expenditure is the only reason why the NHS  performs so badly in comparison, ignoring the poor performance of the Scottish NHS despite receiving more money per capital than the English NHS.

A system seldom looked at is that of Singapore, a wealthy, developed Commonwealth nation.  Singapore operates a system of health savings accounts which puts real decision making powers in the hands of doctors and patients.  Instead of a government funded or an insurance based scheme, Singaporeans save  money in accounts dedicated for healthcare.  Combined with low cost catastrophic insurance cover (90 per cent of people should never need to claim upon this) health expenditure is managed by the individual in association with his or her doctor.  This avoids the rationing and waiting lists experienced by the NHS and bureaucracy caused by insurance based systems.  Of course, a state system remains to act as a safety net for those few unable to save enough to meet their heath needs, but most people are able to manage their health needs without the government. 

Singapore boasts health statistics that are the envy of the world.  Spending only four per cent of GDP on healthcare compared to Britain’s eight, Singapore nerveless achieves better life expectancy and infant mortality results than Britain.  Amazingly they do this with less doctors and nurses per capital than most developed nations, inferring an efficiency that is lacking in centrally planned or insurance based models. 

No doubt Singapore’s densely populated population is easier to service than in Britain.  An Asian culture and diet may also contribute to the startling health statistics produced by Singapore, but this lead must in part be due to its highly innovative and flexible health system.  It is worth serious investigation and research.  Progressive Vision is beginning more detailed research in this area.

KEY POINTS 

• The NHS is providing one of the worst levels of performance in the developed world.

• A new system must be adopted. Singapore’s health savings accounts system is showing promising results.
________________________

Home | About Us | Contact | FAQ |Media Centre | Links | Support Us
Broadcasting | Climate Change | Crime | Education | Gambling | Finance Industry | Health | Housing
Postal Services |Taxation

Progressive Vision, Suite 111, 95 Wilton Road
London SW1V 1BZ
Telephone: +44-207 870 5303 | Facsimile: +44-20-7630 8124