Why we need to reform the NHS


The Guardian is running a month-long series to tell us about that Wonder of the World, the National Health Service. Somewhat inadvertently they've also told us why it needs reform. That reason being that the NHS just isn't actually very good. As they say:

Maligned for long waiting times and disrupted by endless reorganisation, the NHS may not sound like an international benchmark. But the respected US Commonwealth Fund health thinktank ranked the UK first in its most recent study of healthcare in 11 rich countries (June 2014).

The UK came out best in eight of the 11 areas studied, including safety and effectiveness of care and for overall efficient use of resources. However, it was placed only 10th out of the 11 nations for health outcomes and overall death rates.

It's rather worse than that actually, that report is here.

Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives— mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden. Overall, France, Sweden, and Switzerland rank highest on healthy lives.

We ourselves would think that how well a health care system manages to cure people, given the current state of medical technology, is a pretty good indicator of how good or bad that health care system is. The American system has its own problems, that employer paid insurance being one of them, it isolates consumers from the cost of their health care almost as much as the NHS's tax paid model does. It's also true that that system doesn't cover everyone.

Yet the NHS is also an outlier by this crucial measurement: all the other systems which have more diversity in both funding and supplier, including some measure of that dread market competition, perform better. Thus we must reform the NHS so that it performs better: by, presumably, having more of that market competition.