Spot Mr. Monbiot\’s logical leap

Tsk George, Tsk:

This programme seeks to model one of the most efficient and cost-effective health services in the world – the NHS – on one of the least: the US system. OECD figures show that healthcare in the US costs $7,500 per person per year. The OECD average is $4,500. In the UK it costs $3,500. Yet while the US system is plagued with fraud and lawyers, while it overtreats the rich and dumps the poor in the street, the NHS came out top of the countries surveyed in the journal Health Affairs on most measures of public confidence and public access. (The US came bottom.) As Major did with the railways, Cameron wants to take a functioning system and smash it into chaotic fragments.

Why have successive governments insisted on policies that are likely to raise costs and reduce standards?

There\’s a factual error there, the proposed model for UK (actually, English, as it\’s a devolved matter) is not the US system. No one, at least no one in power, is proposing that it\’s all paid for with job relatde private insurance, which is the cornerstone of the US model. Rather, the proposal is that it\’s all paid for by government, with a selection of public, private, for profit and charitable, providers. That\’s the French system, the health care system which is usually described as the best in the world.

However, what\’s much more interesting is the logical leap that is made there.

Sadly, the Health Affairs article is gated, so we cannot go see it. However, we can work from the old WHO rankings of health care systems instead.

OK, so the NHS comes out top in public access (confidence is a measure of how good the propaganda is more than anything else). Fair enough, it\’s a free at the point of use system so you\’d expect it to do well on that measure.

However, from memory, the WHO rankings used a number of different measures. How equitable (ie, tax financed) was the system, public access as described, quality of treatment, how quickly were people treated and so on.

The US system came first in that last measure. To some extent that\’s what makes it so expensive, the amount of redundancy in the system which enables you to have an MRI scan a couple of hours after the doctor suggests you might need one. Or for your radiology treatment to start today rather than in 6 weeks time.

However, when you add all of these different measures up, and the vast majority of them, the weightings given to them, mean that it\’s equity, tax financing, free at the point of use, which make up a great deal more than 50% of the rating, when you add all of these up, the NHS still comes 14th.

Which means that at things like patient access, customer choice, quality of treatment, the NHS must be really rather shite, given how obviously good it\’s going to be at those equity things.

Which leads us to our logical leap. Coming high in public access does not mean that changes in the system are going to lead to declines in standards. Which is exactly what George has said they will do above.

In fact, we actually know the opposite to be true:

In recent research along with Rodrigo Moreno-Serra (Gaynor et al. 2010), we look at all admissions to hospitals in the National Health Service – around 13 million admissions – pre- and post-policy. We find that hospitals located in areas where patients have more choice are of a higher clinical quality – as measured by lower death rates following admissions – and their patients stay in hospital for shorter periods compared with hospitals located in less competitive areas. What’s more, the hospitals in competitive markets have achieved this without increasing total operating costs or shedding staff. These findings suggest that the policy of choice and competition in healthcare can have benefits – quality in English hospitals in areas in which more competition is possible has risen without a commensurate increase in costs.

We\’ve actually observed that competition in the NHS increases standards.

Tsk George, Tsk.