The British National Health Service remains the sacred cow of British politics - any criticism is considered beyond the pale, guaranteed to trigger angry responses and accusations of bad faith. This book argues that the NHS should not be insulated from reasoned debate. In terms of health outcomes, it is one of the worst systems in the developed world, well behind those of other high-income countries. The NHS does achieve universal access to healthcare, but so do the health systems in every other developed country (with the exception of the US). Britain is far from being the only country where access to healthcare does not depend on an individual's ability to pay. Author Kristian Niemietz draws on a wealth of international evidence to develop a vision for a universal healthcare system based on consumer sovereignty, freedom of choice, competition and pluralism. His roadmap for reform charts a path from the status quo to a more desirable and effective alternative.
Author(s): Kristian Niemietz
Edition: 1
Publisher: Institute of Economic Affairs
Year: 2016
Language: English
Pages: 152
City: London
1 An alternative history: what Britain would havebeen like without the NHS In a universe not far from our own 1
Back to reality 17
2 Who should envy whom? NHS performance from an international perspective 26
Cancer 27
Stroke 32
Amenable mortality 33
Waiting times 35
The Commonwealth Fund study 38
Spending and efficiency 45
Robustness to demographic challenges 51
Choice and accountability 54
Conclusion 59
3 A quarter century of NHS reforms: what worked, what failed 62
The internal market of the 1990s 64
The period of ‘ultra-managerialism’ 68
The quasi-market reforms of the 2000s 71
Recent reforms 85
Conclusion 87
4 Other games in town 90
The NHS debate: insular and inward-looking 90
How social health insurance systems work 94
Notable features of the Dutch system 101
Notable features of the Swiss system 107
Notable features of the German system 112
Notable features of the Israeli system 115
Conclusion 117
5 Towards a pluralistic, sustainable healthcare system: a strategy for an orderly transition 119
The quasi-market: finishing the job 119
Free entry and exit 122
Free choice of Clinical Commissioning Group 125
The freedom to opt out of NHS commissioning 128
Vertical and horizontal integration 130
Freedom of choice over the depth and scope of coverage 131
Prefunding healthcare costs 134
Selective contracting 136
Conclusion 137
References 141
About the IEA 152
