Think Pieces

The million-year wait

Written by | Saturday 1 January 2000

Waiting lists are the inevitable consequence of a politically-driven, tax-funded, centrally-run health service. Users have no customer power over the system. Since the amount which people pay (through taxation) is unrelated to the volume of services they use, they have every incentive to demand as much service they can get, however marginal or even unnecessary. And because - unlike almost all other goods and services - there is no price mechanism to inhibit the over-demand, the central authorities have to resort to the only other strategy open to them, that of rationing.

Driving down the work

Written by | Saturday 1 January 2000

2. Anecdotal evidence from health professionals backs up this view held by the Secretary of State for Health. Many health professionals believe that there is scope for a 40% downward shift in healthcare delivery from hospitals to GPs, and from GPs to nurses and pharmacists. The agenda for this workshop asked participants what types of work could be 'downshifted' in this way; what benefits or (negative) implications might result; and what should be done to bring this reallocation about.

A. Reallocating work: from secondary to intermediate / primary care

The NHS: a dysfunctional insurer

Written by | Saturday 1 January 2000

For example, through their tax and National Insurance Charges, UK citizens have to pay for NHS services whether they use them or not. They are not paying simply to guarantee fair access for anyone who needs healthcare, regardless of their ability to pay; they are paying for their own NHS treatment, even if they decide not to rely on it. Instead of rewarding people for removing their demand from an over-stretched public service, in effect we make them pay twice.

Exit will drive reform

Written by | Saturday 1 January 2000

Huge budget increases have not brought the exptected improvements in NHS performance. Nor are they likely to. Some 70% of the NHS budget goes in wages, and increases tend to go there first. Medical equipment and medicines are getting more effective, but they are also more expensive. Meanwhile, the population continues to get older, demanding yet more medical and social care. And because there is no competition, new money shores up out-of-date ways of working, rather than going into the development of innovative systems.

Don't stop the bus

Written by | Saturday 1 January 2000

With the arrival of new, more local, more innovative private bus companies, it seems that people are coming back to the bus. According to our report Deregulated Decade, this fightback has been 'truly remarkable', with buses emerging from a long period of managed decline to become market-led, quality minded, and capable of ending three decades of loss of custom to the car. And yet, local authorities want to continue to run them.

Roads and Congestion

Written by | Saturday 1 January 2000

Our report The Road from Inequity shows that country dwellers pay far too much for road space, while urban road users pay far too little. Car users add to the congestion in towns, making public transport even less reliable and attractive, because there is no economic reason for them not to. The CBI has calculated that the consequent delays, pollution and accidents costs the country billions.


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