Friday, 30 October 2015

Why the flu vaccine illustrates all that is wrong with the NHS

The UK's National Health Service is nudging ever closer to collapse. This fact is blatantly obvious to many. The political will to do anything about it is, however, sadly lacking. It is particularly disappointing that the Conservatives, in a position of strength, seem more interested in tackling the immigration 'problem' that isn't a problem, than getting to grips with the huge and pressing problem that is the health of the nation.
         As I have discussed before in this blog the NHS principle of free health care is simply unworkable in the modern world. That inevitably means some people are going to have to pay for treatment. This is already happening with the slow growth of the private system. Things would be much, much better, however, if the NHS would embrace the willingness of many to pay for better treatment. The flu vaccine provides a small but useful illustration of this issue.
          The flu vaccine is available free of charge on the NHS for young children and people aged over 65. What about the rest of us? More and more people want the vaccine and so a market has emerged to satisfy that demand. Indeed, the jab is now available at most major supermarkets for around £9-12 a shot. This means that many people are paying for a little bit of health care.  
          I don't think anyone sees anything wrong with the fact that some people get the jab for free and some don't. But, here is the crucial point: the NHS is denied the opportunity of making any money on the willingness of people to pay for this service. In our family, for instance, the kids go off to the local GP surgery to get their jabs while my wife and I go off to the local supermarket and pay £9. I, for one, would rather we just pay the NHS £18 and all get the jab at the same time.
        Clearly there is not a great deal of money to be made in flu jabs (although I doubt the supermarkets are doing it for the good of humanity). If the NHS did 1 million jabs at a profit of £1 at time then they still only make £1 million. This is not going to save an NHS short of billions of pounds. It is still, though, extra money that the NHS could make. If there was a willingness to sell other services then we might find the billions that are needed.
          The most common criticism of the NHS charging for some services is that it would create a two tier system. But, what is the problem with a two tier system? The beauty of a two tier system is that it can benefit both rich and poor. The rich gain because they can use their wealth to purchase a better quality service. The poor gain because the extra money coming into the NHS can improve services. Sure, there will be inequality. Everyone, though, gains. 
        As an example, consider waiting times to see a doctor. In the current climate a patient can consider themselves lucky if they get seen within an hour of the allotted time. Some people would be willing to pay to reduce that waiting time. Clearly, an option of fee for timely appointments would benefit the person who gets the 'better' service. The money that person spends can, however, be reinvested into the system to provide a better service to others.
      Indeed, those in the second tier may actually benefit most because they get the improvement for free! For instance, suppose it costs £100 for a timely appointment. Then the rich person gets seen on time but has to pay £100. Suppose that the extra revenue in the system reduces standard waiting times to 20 minutes. Then poor people get a better service and pay nothing for it. Everyone is a winner.
          So, rather than 'accept' that fee for service is 'necessary' for the NHS to survive, why not start to embrace it as something that can reinvigorate health care in the UK for everyone

2 comments:

  1. What is the guarantee that the extra money goes into improving the system? Why should doctors and nurses in the private tier give up on their earnings to cut waiting time for the public tier? That is what is wrong with a two-tier system. You have only focused on a segment of the system and looked at it out of the context of the environment ignoring the fact that there will be other forces that will result in the service for the poor deteriorating over time in a two-tier system. A two-tier system may only (if ever) succeed in the presence of great supervisory forces (like the government). An example would be germany, where the quality of the public tier is not dependent on how much money the private sector makes!!

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  2. What is the guarantee that the extra money goes into improving the system? Why should doctors and nurses in the private tier give up on their earnings to cut waiting time for the public tier? That is what is wrong with a two-tier system. You have only focused on a segment of the system and looked at it out of the context of the environment ignoring the fact that there will be other forces that will result in the service for the poor deteriorating over time in a two-tier system. A two-tier system may only (if ever) succeed in the presence of great supervisory forces (like the government). An example would be germany, where the quality of the public tier is not dependent on how much money the private sector makes!!

    ReplyDelete