Saturday, January 01, 2005

Does the NHS have enough money

Finally, my reply to Lewis's post from before Christmas. The meat of his article seems to be this comment.

...a deeper problem that I think is at the heart of the NHS - that of money, or more accurately that of there not being enough money.

So, is Lewis right?

On the face of it, of course he is. If we spent more money as a society on health, then the service we can provide will be more. That is correct for all levels of funding, more is always better. But are we spending enough money? If not, how much is enough, and how do we provide that funding.

Lewis's answer is basically to privatise the NHS, with the belief that the private sector can do things more efficiently than the public sector. In a way he is right, but the price might be more than we would like to afford.

The United States spends $4,887 per person per year on Healthcare but the United Kingdom spends $1,989 per person per year (source WHO), to bridge that gap would be around £75 billion per year, but the Life Expectancy figures for males are 75.8 years in the UK and 74.6 in the US, for females, it's 80.5 in the UK and 79.8 in the US. So we spend much less, but have a comparable average outcome, why is that?

The easy answer is that the NHS is more efficient, but you say, how can the NHS possibly be more efficient than the United States. Well, there are obvious reasons.

1. Advertising. I was watching an NFL game on Christmas Eve, and spotted an advertising hoarding high up in Giants Stadium, HSS - Official Hospital of the Giants You couldn't imagine something like that in the UK could you? If you have a multi provider system, then you will be spending money on advertising.

2. Invoicing. Right now, East Somerset Trust employs just one person to do all our invoicing and that's not even all her job, under a US style system, there would be a whole department getting money in.

3. Litigation. This adventage may be eroding but there is more defensive medicine being performed in US hospitals, that is procedures and tests that are not medically valid, but performed in order to defend against claims of negligence in a law suit later on.

4. Drugs. the NHS's drugs are cheaper because if NICE (National Institute for Clinical Excellence) doesn't like the price, it won't support it, if it's not NICE approved, the drugs company can't sell it to the NHS and that's a big customer to lose.

5. Single Employer. Consultants are paid double NHS rates in the US, Nurses around 50% more, because there's a single rate for staff, wages can be surpressed. Although, I like everyone else would love to be paid more, it's still an advantage to the NHS.

Most of these advantages would be wrecked were the NHS to be broken up. I would never say we didn't need more money, but the NHS doesn't need the extra £75 billion/year that it would take to lift us to US level funding.