Polly and evidence

Collaboration, not competition, that\’s what we need says Polly.

Quite ignoring the fact that markets are the way that human being collaborate. Sigh.

She uses as her example, as the way that collaboration works, the decline in deaths from heart attacks.

But destructive fragmentation is what the new competition system will do, Boyle says. He has stopped vainglorious consultants competing, except to become the single local centre of excellence. He was wrestling with reducing the number of child heart units as he left: the Royal Brompton, losing out, has gone to judicial review – to the NHS chief executive\’s reported fury at the waste of money – but specialism has to be concentrated. These are necessary rationalisations that can only be done by an overall authority bringing local doctors together: 500 consortiums are not the answer. He gives one example of how the new GPs\’ consortiums risk disrupting treatment with arbitrary behaviour: in every area one specialist hospital is always open on a rota for heart attack and stroke patients. Wigan and Whiston, nine miles apart, take it in turns. But one consortium refused to send its patients to the other town – so the system breaks down in fragmentation and daft localism. That\’s competition instead of collaboration. \”Look at our results. Now show me any evidence that NHS competition achieves as much.\”

Yet economists using econometric analysis say they can prove competition works – and that\’s what cuts heart deaths. What\’s more, they say their measurements of heart deaths hold good as a model for all treatments. Boyle ripostes that it\’s \”bizarre to choose a condition where choice by consumer can have virtually no effect\”. Patients suffering \”severe pain in emergencies clouded by strong analgesia don\’t make choices. It\’s the ambulance driver who follows the protocol and drives to the nearest heart attack centre\”. From 2002 on, \”groups of clinicians and managers across England have been working together, collaborating, to bring about improvement in outcomes\”.

But the thing is, those economists can show this.

\”Dr Cooper and colleagues looked at data for 433,325 patients who had heart attacks between 2002 and 2008 – covering the period before and after fixed-price competition was introduced – at 227 hospital sites in England.

They found that death rates dropped by about 7 per cent under the new regime, and fell quicker in “more competitive markets”. The number of patients being treated also fell.\”

Note the important point there: heart attack rates are falling everywhere, have been for years. So have survival rates been rising for decades. It’s that the improvement in survival rates was greater where there is competition.

It\’s not that the patient making a choice improves the treatment the patient gets. It\’s that the patient having a choice, whether exercised or not, reduces the manner in which the local hospital is a monopoly and thus improves the performance of said hospital.

Come on, it\’s hardly an unusual finding that a monopoly offers crap service/prices now, is it? In fact, I find it really quite worrying that there\’s quite so much doublethink around. The very same people who point to the big six energy suppliers ripping off their customers as an oligopoly insist that such could never happen in the NHS monopoly. What sort of cognitive dissonance do you have to suffer from to believe both those things?

We\’ve direct evidence that competition saves lives: yet still there are people who reject competition in the name of saving lives.

9 thoughts on “Polly and evidence”

  1. I have to say, reading a Polly Toynbee article on either the NHS or the economy is rather painful, as she is both ignorant and hysterical. She also claimed in this article “He [Cameron] knew electability rested on oozing love for the NHS so he promised to leave it alone, even using his son to prove his commitment to all the NHS stands for”, which is a rather disgusting assertion. I doubt she’ll apologize for it, as it’s not quite at the same level as “the final solution for the poor”.

  2. Tim,

    You know that lefties like our dear Polly here have their a priori model of the world that just churns their input assumptions around in ever decreasing circles.

    What their model churns out is of course impervious to empirical evidence, which is rejected because it doesn’t conform to the model.

    Sounds like something else, actually…

  3. Again, I don’t think Dr Cooper is actually measuring what he thinks he is measuring – beyond the (very general) point that better access to healthcare in any given area = better outcomes. Quite simply, it’s daft to pretend that “competition” explains improvements in AMI related mortality, not least given advances in treatment, better protocols, increased investment, lifestyle factors etc . Hospitals might well be raising their game in response to perceived notions of patient “choice” or the threat of losing services, but it’s not directly driving acute care in the way that you seem to think. All very well sighing that markets are how people collaborate – that seems to be a definition that is elastic to the point of being useless!

    reduces the manner in which the local hospital is a monopoly

    A while back, you wrote about your father recieving prompt intervention when he needed it – the result, no doubt, of a bunch of people co-operating in timely fashion. That would be true of any developed healthcare system. I certainly don’t hold a candle for Polly, but it’s precisely that kind of capacity that we are in danger of fragmenting.

    Tim adds: We’ve just had two pieces of research that show that there is a correlation (at least) between more competition and better health care outcomes.

    This is on top of the more general increases in outcomes happening anyway. And the reaction to this, as best as we can measure stuff result, is that it’s “daft”?

    Come on, apply your mind for a bit. We all know damn well that a monopoly food service provider would be crap (I’ve lived in Russia under rationaing: it was crap). A monopoly anything is a crap provider.

    Why is it that anyone at all thinks that the NHS is different?

  4. Tim- thanks for replying. What I find ‘daft’ is the Cooper paper being hawked about in defence of the ConDem reforms (in whatever form they take… & it’s being used to justify all manner of stuff). Yes – a monopoly food service would be crap, but that’s certainly not grounds for underestimating the importance of co-operation in the provision of acute services!

    Tim adds: Please note that I’m not stating that the current reforms are correct. Only arguing that this (from Polly etc) condemnation of competition as reducing effectiveness appears to be, from the empirical evidence, wrong.

    Why it’s wrong would be an extremely interesting question. But I’m arguing only about the insistencer that it is wrong in the face of all the evidence we have that comeptition does increase efficiency (defined as saving more lives for the same amount of money).

    I’m entirely open to the idea that “too much” competition is worse: there are indications that price competition isn’t all that good an idea here for example.

    But when the evidence says “competition good” then those still shouting ” competition bad” deserve to be shouted at.

    You know, Murphy, Polly, every trade union leader (yes, including the BMA) and so on.

  5. Please note that I’m not stating that the current reforms are correct,/i>

    Don’t worry, I guessed that.

    Nor do I dispute the value of genuine (informed) patient choice as a means of keeping service providers on their toes. In that respect, competition is indeed icing on the cake (and Cooper might registering this to some degree, though I would hold that there has been a good deal less actual competition going on than he believes – see bloc contract ISTC referrals, etc). Nonetheless, it certainly doesn’t invalidate the massive importance of staff/units/hospitals co-operating with each other – in this or any other healthcare system.

    I suppose my real concern is that the political language of choice & competition is all too often being used as cover for something else – namely handing everything over to Crapita. It doesn’t excuse Polly’s frequently-polarised tone, but even so…

    Tim adds: OK, but look at it from my point of view. We’ve got loons like Murphy stating that competition requires excess capacity. We can’t afford excess capacity so we shouldn’t have competition.

    That’s it, that’s his argument.

    That’s the 19th century socialist argument again. No, really, it is. They really did think, up to the 1950s in fact, (Shaw, Wells, the Fabians, that lot) that planning, no competition, would be more efficient than market competition because market competition is so wasteful with all that excess capacity.

    And we ran that experiment. E v W Germany. Hong Kong and Taiwan v Mainland China. N v S Korea. E v W Europe. We know, absolutely, that the argument is wrong. Market competition might indeed be wasteful, that spare capacity might not be a very good idea in a static economy. But that market competition seems to work just that little bit better over time. Maybe only 1 or 2% better each year. But over 35 years that doubles production.

    As an example, decent economists (ie, not just my highly partisan ones) say that the Soviet Union did not manage to have any productivity growth at all in its 70 odd years. Place got richer, yes, but only by having more inputs: people, raw materials, capital etc. Their production, their y of output from x of inputs was the same in 1991 as it was in 1917.

    By contrast, 80% of the growth in the western, market, economies, came from such productivity growth. So of the growth of real GDP per capita in the UK, from £4k to 18k over the century, £11k of it, 80% of it, came from that market competition part.

    *That’s* why we want it, for the long term.

  6. Econometrics is bunk, which is why the Austrian School wisely rejects it on principle. The economy is a dynamical system. You can never show that an apparent correlation reflects causation.

    I’m a free market kinda guy, but claiming a WINZ for “competition” like this just seems utterly hokey to me. Oodles of variables, non-linearity, you can’t correct for it all no matter how hard you try.

  7. The NHS is absurd, no doubt.

    The interesting part about your post for me is that electricity supply really is a natural monopoly and ought to attract a high proportion of the rental value of the property.

    By arguing against electricity companies’ monopoly profits, people are actually arguing in favour of those profits going to the landowners.

    So having an ancestor (by purchase) who won some battle in the middle ages is apparently a better claim to the value of the electricity network than having one who (admittedly with state support) actually built that network.

    Not really consistent with a left-wing position, I think.

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