Letters in The Times 14th April 2016 add to Melanie Phillips opinion posted yesterday. Health Insurance … (Fundamental dishonesty. Let’s abandon our broken NHS and move on – The only solution to the health service’s problems is a continental-style insurance scheme )
Sir, Melanie Phillips is right that the only solution to the NHS’s problems is a continental-style insurance scheme (Opinion, Apr 12). This has been indicated ever since 2005 in our annual Euro Health Consumer Index, which compares and ranks European national healthcare systems. Continental “Bismarck” health insurance systems outperform the British, Italian, Spanish and Nordic “Beveridge” systems. This is particularly true for accessibility — ie, the absence of waiting lists — where even oil-rich Norway has problems.
The continental systems have much less micro-management from on high, and rely more on responsibility and accountability being shown by the medical profession. Particularly in the Netherlands, this is boosted by a legal obligation for the profession to liaise with patient organisations. In other words: let the professionals run the show, and make sure they talk to their customers frequently.
The NHS’s problem is most likely not a lack of resources: it is inherently cheaper to run a healthcare system without waiting lists than to have them. Waiting lists create extra work, draining the healthcare organisation of resources. I know this from having been CEO of the University Hospital of Northern Sweden, where I was hired to cut costs. After three years of cutbacks, involving reducing the number of staff by 1,000, we ended up operating the first waiting list-free large hospital in the country since at least 1945.
Professor Dr Arne Björnberg
Chairman, Health Consumer Powerhouse
Sir, The track record of private contractors for NHS and social care services is mixed, to stay the least, and Melanie Phillips does not name one example where they have outperformed incumbents. Nor is it inevitable that the only way forward is mixed insurance models. The NHS, as a dominant-payer model, keeps costs down and ranks highly in several international studies on equity of access, efficiency and value for money. It is more poorly funded, staffed and bedded than most systems in the OECD. Rather than talking it down, we could instead choose to fund and staff it properly.
Professor David Oliver
Sir, Melanie Phillips omits to mention that our northern European neighbours spend far more than we do on healthcare: on a comparable basis, France 20 per cent more per capita, Germany 30 per cent more, Holland 50 per cent more, etc. She also seems to think that European healthcare is uniformly better than ours. It isn’t. Studies comparing nations’ healthcare show that some European countries perform better than we do and some worse.
Nobody is suggesting that the NHS does not have significant problems that need fixing, but an insurance-based system is not the answer.
Fenton Pits, Cornwall
Sir, I have been privileged to be a consultant in the NHS for 27 years: it delivered my children; it cares for my elderly parents; it replaces my friends’ hips and knees and provides them with state-of-the-art pacemakers; it treats their cancers and manages their chronic illnesses. According to the Nuffield Trust, which ought to know these things, the NHS is stable or improving in 25 out of 27 international indicators, and it does this with a financial efficiency that shames many countries with much larger health budgets.
The NHS is far from perfect. It is bureaucratic, cumbersome, underfunded and has no control over the ever-increasing demand on its services. Working in the NHS can be Kafka-esque and frustrating, and many of us could tear our rapidly greying hair out on a regular basis. But it does miracles every day, and we need to remember and celebrate this.
Dr David Bogod
West Bridgford, Notts