Universal Coverage’s Mixed Picture
April 16th, 2008
by
Jonathan Gardner
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In interviews with Health Affairs, government ministers in Germany and the Netherlands talk up market-oriented refinements to their universal health insurance systems for the future. But the news from Europe isn’t all happy: an unsettling survey in the United Kingdom finds that some physicians believe that the market will unravel the government-owned and -operated National Health Service (NHS) in the next decade.
The online poll of more than 500 general practitioners (GPs) conducted by Pulse, which describes itself as “UK’s leading medical weekly,” found that 84% believed that the NHS would not exist “as we know it” in ten years’ time and that only one-third believe that the NHS will be free at the point of use in the same amount of time.
Given that the publication does not disclose the survey’s methodology, it’s not clear whether the poll is reflective of British physicians’ attitudes. But it more than likely reveals an unease with some reforms within the NHS as well as incursions by the private market, including Richard Branson’s Virgin health centers, the first of which is scheduled to open this summer. Indeed, the Pulse poll reveals that one-quarter of its respondents had been asked to join a private firm, and the publication itself is mounting a campaign in opposition to the private clinics.
In a larger context, however, the place of the NHS in the health care systems of industrialized economies is in question. In the Euro Health Consumer Index 2007, the Stockholm-based Health Consumer Powerhouse scores the NHS as a “mediocre performer,” scoring seventeenth of twenty-nine on such indicators as patient rights and information, waiting times, outcomes, and the generosity of the medical and pharmaceutical benefit.
In issuing the report, the Health Consumer Powerhouse comes to this conclusion: “Bismarck Beats Beveridge,” meaning the systems of national health insurance modeled on the nineteenth-century reforms of Otto von Bismarck in Germany outperform those modeled on government ownership of health care providers via the NHS, the brainchild of William Beveridge.
But even confronted by the challenges of the market, its European counterparts, and, indeed, its own doctors, the NHS seems to be confident that private competition will make it better, not worse. As a government spokesperson told Pulse: “GPs who think an NHS free at the point of use will no longer exist in the future are wrong. We will never change the core values of the NHS. The independent sector has helped improve health services for patients, helping speed up treatments, reduce waiting times and galvanize the NHS to raise its game.”
