Thursday, April 28, 2005

Funding the NHS

It is generally accepted that the NHS should be free at the point of use in the UK otherwise the poor suffer disproportionately through a lack of healthcare. Should the NHS always be free at the point of use or should patients partially fund certain treatments beyond what they already pay in taxes? Current NHS funding seems to be a classic example of moral hazard. If individuals smoke or drink alcohol excessively for example, all treatments to cure their conditions are free on the NHS. Would it help to concentrate their minds before abusing such substances that they would have to pay 40% or 50% of the cost of the treatments in addition to any excise taxes they may already have paid on using the products? Many would say that this is a radical funding policy for the NHS and yes, it is, but would the nation as a whole be healthier if individuals were more responsible for their own lifestyles and were effectively rewarded or penalised accordingly?

Beyond Government funding, the existing method of funding the NHS could never exist. No one proposes that car drivers should pay for their car insurance on the basis of how much they earn whilst totally ignoring the driver's individual risk of having a crash or previous claims history. A driver has a vested interest in driving carefully and avoiding accidents otherwise their premiums rapidly increase. Why can't this be applied to a limited extent within the NHS? Without the "goal" of driving safely to keep your premiums down, I suggest driving would become a lot more dangerous as people no longer worried about their claims history or driving record but just the inconvenience of getting the car repaired after each accident.


lascivious said...

"Would it help to concentrate their minds before abusing such substances that they would have to pay 40% or 50% of the cost of the treatments"

The problem is, how do you know if someone smokes, drinks too much or eats badly? Not everyone who gets lung cancer smokes, not everyone who gets liver cancer drinks too much and not everyone who is fat eats at Macdonalds every day. There is a statistical correlation between these diseases and lifestyle choices, but you can not form a direct causal link and there are those people who get the disease who don't have a bad lifestyle; they are just unlucky.

Also, where do you stop? People choose to drive their cars and they have crashes - so do they have to pay? People choose to go skiing and break their leg - do they have to pay? People choose to go to the park at night and get mugged - do they pay?

A nice idea, perhaps, but somewhat impractical. A better way of doing it is the Swiss system. It's a bit like car insurance - you have an excess system, which discourages silly trips to the doctors. If you choose to pay less per month for your healthcare, the level of this excess goes up. It is government underwritten - the private companies that give you insurance are only libel for a certain amount of money per year per person, then the government pays. So if you get really sick, you still get (the same good) healthcare. Also, you get free healthchecks for weight, lung capacity, general fitness, disease screening, blood tests for everything under the sun...... If you lead a healthy lifestyle, you pay less. If you don't, or you choose not to take the test, you pay more.

The above system is fair, cheap and it works. It's mid-way between the socially unjust American system (have you been to a public hospital?) and our overly burdened, expensive and inefficient NHS.The problem is, if the Tories announced such a drastic change to the NHS, they would not win an election. People in this country want everything given to them without having to lift a finger; all rights and no responsibility.

Snafu said...


If you drive a car and crash, you are "charged" as the NHS is able to recover their costs from your insurance company. If a person skis and breaks their leg, surely their insurance should pay for the medical bill rather than everyone else chipping in? I know that it is not a perfect solution to a serious issue but still think on average it's a fairer than the present one recognising the inconsistencies you highlight.

I hadn't heard of the Swiss system before but it sounds like they have found a good compromise. However, as you say, the Tories would be bundled outside if they ever dared to suggest such a radical plan!!

lascivious said...

Alas, being charged for the NHS in a car accident or skiing accident doesn't happen. If it did, doctors would take your insurance details! For example, I know someone who rode a mountain bike down a mountain whilst on holiday. He fell off and broke his shoulder, arm and collar bone. His travel insurance paid for the initial treatment and the floght home, but as soon as he got home, the NHS picked up the bill.

The problem is, a truly private healthcare system (for example, the UK in the 1850's) or something closely rated (America) means that the people who are seriously ill pay more. If you are ill, the chances are you can't work. It isn't a very just society - the fact that we look after our needy, in my opinion, is a good thing. On the other hand, with our current system, lots of people are "ill" when they don't have to be and lots of people are unemployed when they don't have to be. It's too far the other way.

I want a nice happy medium. One where individual responsibility is paramount, but the sick and needy
still have a safety net. How do you do it?

Snafu said...

Lascivious, you may not be charged directly for your treatment following a car crash, but you do pay through increased insurance premiums!!

lascivious said...

Wow - I was not aware of this! Thanks.. I will post later on it.

David Vance said...

How about abolishing the rotten NHS?

Snafu said...

Who could possibly recommend scrapping the third or fourth largest employer in the world? The fact that no other country in the world tolerates a system such as the NHS shows how backward they all are!!