In response to Nick Booth: Where the NHS goes wrong, by our man on the front line,
Peter Gardner wrote: Lovely article, Nick Booth, and right on the money. It really is about incentives. I have emigrated to Australia which has a reasonably functioning health system (let’s not overstate it but it is impossibly near perfection compared with the NHS). The root problem with the NHS is the absence of management incentives. In Australia every patient gets a bill and the patient decides whether it is to be paid by themselves, their insurance company or the taxpayer. People know how much treatments cost – especially pharmaceuticals. The money follows the patient. There is no postcode allocation of GPs and hospitals. Good providers attract patients and do well, bad ones go out of business. When you need treatment, you discuss the options including consideration of waiting times, where to get it, what kind of treatment, what it will cost and you decide. The best is not always the most expensive.
Almost all GP surgeries have EFTPOS facilities. You pay the bill, and Medicare (the taxpayer-funded government agency) pays its contribution direct into your bank account. Where appropriate an insurance company does the same. Or you can claim afterwards. Visitors have to pay and claim from their insurance company afterwards. However, GPs have discretion – it’s their surgery and up to them whether to bear the cost themselves. How many GP surgeries in UK are even equipped to receive payment?
Broadly similar principles with hospitals.
The last time I went to a pharmacy in UK with a prescription I asked what the medicine actually cost. The pharmacist had no idea.
Tony Blair infamously said patients don’t want choice, they are not qualified to choose, they just want good medical treatment. Perhaps he has no friends or neighbours. Most people ask friends and neighbours about their experiences and for recommendations. Bad news travels fast. In UK asking for a second opinion is regarded as extremely rude. Not in Australia.
There is still government regulation. For example, every pharmaceutical and medical procedure has a price agreed with the government. Providers may, within limits, charge more or less as they choose but the government will pay only the agreed price. There are regulations to stop people hoarding medicines etc etc. But the incentive of competition and, dare I say it, moderate profit is maintained judiciously. It is not a free for all.
