Why has no other European country copied the NHS model?
7 November 2019
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No other European country has copied the NHS model in half a century. Almost all comparable countries use a mix of funding mechanisms, rather than relying on taxation alone, and most outperform the NHS in health outcomes.
UK cancer survival rates lag behind those of comparable countries, A&E delays are increasing, the number of operations being cancelled is dire, staffing rates are in freefall and the tick-box target culture is sending doctors and dentists screaming into the private sector. The UK has one doctor for 356 people, against a developed world average of one for 277.
The NHS’s archaic divisions of labour between GPs, hospital doctors, pharmacies and clinics is now indefensible. So too is the division between the NHS itself and social and domiciliary care. As any victim of these restrictive practices knows, treatment delayed is treatment denied.
Sooner or later, the pressure of demand (now from all age groups) will force the NHS to choose between rationing by some form of means-tested pricing or by further bureaucratic delay. Last year’s Guardian survey of foreign systems showed there were plenty of other ways to organise public health. Before the coming of the NHS, London’s (local) health service was regarded as the best in Europe. It is not that now.
So what are the alternatives?
In countries without the NHS what does healthcare and insurance look like for sick, older or poorer people? Are the rich able to purchase a luxury tier of healthcare and what happens if your insurer goes bankrupt in countries like the Netherlands, Switzerland, Germany, Belgium or Israel?
To discuss, the IEA’s Darren Grimes asked Dr Kristian Niemietz to join him, author of ‘Universal Healthcare without the NHS’.
5 thoughts on “Why has no other European country copied the NHS model?”
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Is the NHS too big and ‘established ‘ to change, even if it is wanted and needed?
Why wont the British public let go even though they know it doesn’t work?
A majority government needs to take it on. It will need massive planning. How about ‘test’ areas? Would this work? I was in Croatia where everyone has to pay the first 20%. No one in A&E! (What are their outcomes?).
. Who has the answers? People with money always get a better service anyway so why don’t we stop worrying about two tier systems? So many questions.
Of course the NHS needs improvement, but after years of entrenched underfunding the Service has not had the capacity to explore other avenues of development.
Its stuck in the model it’s in primarily due to poor funding and lack of clinical and operational development to aspire to a new way of working.
The NHS needs politicians to stop interfering in its operational structure and to allow the coalition of directors and business associates with excellent track records from across successful businesses and healthcare organisations to come together with innovative solutions towards transforming the NHS.
Innovation cant come from Whitehall…..that’s why we’re in the pickle we’re in.
Why do we assume the issues with the NHS is the funding model and there is a role for profit taking insurance companies? Isn’t it enough for government to ring-fence a portion of the National-Insurance contributions to fund the NHS. The issue then being how to manage demands on the system. Private insurance opening hospitals and paying more to the same specialists can create longer queues for NHS as this must cause costs to rise. Floating all medical procedures in a market will drive up costs for patients, as the NHS is able to negotiate down prices. Britain has long attempted to get value for money, partly through efficiencies. It doesn’t look to increase other things like “choice”. Value and efficiency may mean that the UK has fewer doctors. Comparing systems depends on the values each system is trying to achieve vs outcomes. Not outcomes alone, as these can be cherry-picked.
It is not rocket science. It just needs someone to look at the system, see where the economy lies in administration and the main thing is the follow up in the community health system. If someone can be discharged from hospital they should only be discharged if there is proper care in the community which there is not. Many people are looked after in hospital because they cannot be cared for at home and this causes bed blocking. Release of hospital beds would help but sometimes there is just a refusal to acknowledge someone actually needs a bed. This is caused by the admin people not always by the health experts. However they often are doing the best they know how but are hampered by strategic
decisions not of their own making. Need I go on. I do not think underfunding of nurses is the simple answer for example.
Certain European systems, notably in the Nordic countries and the Mediterranean sub-region do share important features with the NHS systems of the UK. It is true that the social health insurance is the dominant Western European model, but not the only model. See: Guido Giarelli and Mike Saks (eds.) National Health Services of Western Europe: Challenges, Reforms and Future Perspectives. London: Routledge, expected 2023.