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July 09, 2007

Neil Harding on the Health Service

Neil does it again:

A lot of extra funding has been taken up (...), by wage increases for nurses, doctors and other staff and also by rampant price inflation in the drugs and medical equipment markets.

Yes Neil. That's actually what the complaint is. By pouring more money into an unreformed system all that was achieved was inflation, rather than the desired goal, which was an increase in health care.

According to the latest WHO report, the UK is 26th in terms of per-capita funding and 18th in terms of health performance (measured over a range of health indicators). By comparison, the US is 1st in per-capita funding and 37th in terms of health performance. This suggests that the NHS is by far more efficient than the free market US model.

It suggests that the NHS is more efficient than the US model using the "range of health indicators" in creating the rankings. As 25% of the weight in those rankings is "health care", 25 % is "inequality of health care provision" and 25% is "fairness of funding" you might actually find that the figures do not quite support your claim of efficiency.

For example, the second weighting. If everyone waits 6 months for a hip replacement then that's equal. If some wait 4 days and others wait three months, that's unequal. But in that second system, everyone is getting better treatment than in the first.

So in creating our rankings we are measuring equality as importantly as the actual level of care.

Similarly, "fairness of funding" is deliberately constructed so that tax financed systems look better than out of pocket or insurance based ones.

What the WHO rankings are measuring is not actually what you think they are: not "which system provides the best health care" but "which system provides the most equitable tax financed health care" (50% of the marks for the latter, only 25% for the former).

All of which is fine, of course, as long as we know that's what we're measuring, and we don't use the rankings to imply "efficiency" of health care provision.

July 9, 2007 in Health Care | Permalink


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Remember this from March 2006?

"Sir Nigel Crisp, 54, the Department of Health's top civil servant, stunned Whitehall by announcing his resignation after reports of a breakdown in relations with Patricia Hewitt, the Health Secretary.

"Rumours about his future have been circulating for months as NHS debts have grown. Despite the record £74 billion poured into the health service this year, total deficits are predicted to be between £800 million and £1.2 billion. The Department of Health will only confirm the half-year figure of £620 million."

The government wanted to centrally negotiate NHS pay back in 2003 so it can hardly disclaim responsibility now for the consequences that followed:

In 2000, the government had appointed Sir Nigel Crisp to run both the Department of Health, as Permanent Secretary, and the NHS as the Chief Executive:

"[Sir Nigel] Crisp was appointed as Chief Executive of the NHS and Permanent Secretary at the Department of Health on 1 November 2000. He is unlike his predecessors or successor in combining these posts. . ."

And with a degree in philosophy from Cambridge, having joined the NHS in 1986 from a background in community work, where he worked in Liverpool and Cambridgeshire, and industry.

Posted by: Bob B | Jul 9, 2007 2:52:11 PM

Table 10 of the WHO report gives the metrics you're looking for - efficiency of the healthcare system at transforming expenditure into disability-adjusted life expectancy. This doesn't include any inequality or financial fairness criterion. The USA is 37th on this measure although the UK is 24th not 18th. Note as well that it's an estimate for 1997, ie before the big increases in NHS spending (and fashionable as it is to say that this merely led to inflation, actually 1) it massively improved the capital/labour ratio in the NHS and 2) paying better salaries for doctors and nurses was something that obviously needed to be done sooner or later, and we have now at least stemmed the disastrous flow out of the nursing profession).

Tim adds: This is the weighting for one of the WHO ranking systems:

"To make the definition of the composite easier to understand, these survey results have been rounded to the nearest one-eighth so that the final weights to be used are 0.25 for health, 0.25 for health inequality, 0.125 for level of responsiveness, 0.125 for distribution of responsiveness and 0.25 for fairness of financial contribution."

That's quite a lot of inequality and financial fairness being considered there.

Posted by: dsquared | Jul 9, 2007 3:43:41 PM

Nice try Tim, but even middle class people in the US want a system like our NHS.

Where would YOU prefer to be ill or seriously injured if you had little or no income?

Lets face it, unless you are sitting on a pile of wealth and most people are not - if you are ill or injured you are not in a position to earn much. Also insurance companies will do all they can to avoid paying out - this is the problem. Governments (much as you dislike them) are far more reliable than insurance companies when you need help.

Tim adds: I don't think there's anyone in hte US at all who wactually wants something like the NHS. A system different to hte one they have, perhaps, but not our.

Posted by: Neil Harding | Jul 11, 2007 10:59:00 AM

[This is the weighting for one of the WHO ranking systems]

well whoopty doo but the two tables I cited don't make that adjustment and the USA does pretty badly on them too.

Posted by: dsquared | Jul 12, 2007 8:40:18 AM