Though the Treasury is almost genetically sceptical of hypothecated taxes, the idea is popular among health officials and, more surprisingly, Conservative MPs. Andrew Haldenby of Reform, a think-tank, suggests that there could be charges for services such as seeing a GP, as is the case in about two-thirds of members of the OECD rich-country club. Though this idea is controversial, the NHS has since charged for seeing a dentist and for prescriptions. Then there is a more radical option: ditch the taxpayer-funded model altogether and replace it with health insurance.
Typically the French, Swiss or German model of universal social insurance is pitched, as opposed to the American model.
This is not a new idea; William Beveridge, who proposed a national health service during the second world war, preferred it. Its supporters argue that in countries that mandate health insurance, more money is spent on health and outcomes are better, partly as a result of competition between providers.
After the chaos of the reforms there is little appetite for a shift in funding models.
Most officials, and not only in the health department, believe that the cost of moving to social insurance would outweigh its benefits. They argue that what you spend is what you get: Britain spends less on health and its outcomes are worse than those of its peers. So the NHS must do more with what it already spends. A sign of inefficiency is the 6, patients in English hospitals who are ready to go home but not yet discharged, up from 4, in They cost the service hundreds of millions of pounds per year and obstruct others from treatment.
The bed-blockers themselves are harmed, too. Some delays are the result of council cuts: about , fewer old people receive social care than in , meaning that hospitals are sometimes used as expensive alternatives to care homes.
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But most are due to how hospitals are run. Rates of deep-wound infection, an avoidable complication, vary from 0. And implementation of good ideas takes too long—about 17 years for scientific discoveries to enter day-to-day practice, by some estimates. This is not helped by the way hospitals are paid. The NHS tariff system rewards repeat activity rather than innovation. Patients instead came into hospital for more expensive treatment.
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This conservatism is also apparent in its approach to its workforce. It employs 1. But England has more shortages of hospital staff than other rich countries. Overtime costs rose, too. Some of these problems would be fixed by recognising that there are too many hospitals. Across the world hospital chains are scaling up. Specialised care is better at scale. In Germany, higher-volume cancer-treatment centres have fewer complications than others.
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Fewer people have died of strokes in London since it merged 32 specialist sites into eight. In a recent review for the government, he suggests that the trusts that run hospitals should be reduced to larger ones. It could be made easier for high-performing trusts to take over bad ones, and for private providers to take over failing hospitals. Yet making up the funding shortfall through efficiency savings alone would require a bigger gain in productivity than any in the history of the NHS.
And the fundamental problem remains that demand for hospital services is outpacing what the NHS is supplying. This is partly about public health. About one-third of English children are overweight, compared with an average of one-fifth across the OECD. Nevertheless, funding for public health is falling and the new government has slimmed down plans to reduce child obesity. This will only increase pressure on the NHS.
In response, it will need to rein in demand for expensive hospital treatment by changing how non-hospital care is organised. Since the NHS is largely free at the point of use, governments have managed demand via GPs, who act as gatekeepers to hospital and prescriptions.
They are ill-equipped to deal with rising demand. If hospitals have suffered from relentless overhauls, GPs have received malign neglect. Though the vast majority of contacts between patients and the NHS are carried out by GP practices, they receive only about one-tenth of the NHS budget.
Their funding is based on the number of patients in their area adjusted for demographics and whether the GPs meet targets set by the government. Gwyn Harris, medical director of Modality partnership, a group of GPs, goes further.
The worst doctors have the best returns. On average, the framework made GPs some of the highest-paid family doctors in the world when it was introduced in But since then it has become less generous.
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This, and poor planning, has led to a shortage of them. England needs 5, more in the next five years. The NHS is mulling a deal with Apollo, whereby the Indian health-care firm supplies enough doctors to fill the gap. Improving the GP system so that it can cope with rising demand will require it to move away from its artisan model, embrace technology and work more closely with hospitals and other parts of the health service.
A few GP sites are already expanding. In Birmingham, 17 practices run by Modality cover 65, patients. Its GPs are salaried rather than partners, following a trend seen elsewhere in the world most American doctors were self-employed a decade ago, whereas now less than a quarter are. Modality has a single call-centre for booking patients. Nurses and doctors often attend to patients by phone or video-link.
This has reduced no-shows while allowing GPs to spend more time on complex cases. GP practices are also belatedly embracing technology. But two practices in Essex, for example, are trialling Babylon, an app that uses machine learning to diagnose symptoms. Others are cleverly using data. When Paul Mears became chief executive of Yeovil hospital he used customer segmentation techniques learned in previous jobs at British Airways and Eurostar.
To integrate them he launched Symphony, which cares for Mrs Evans. Symphony took inspiration from the Esther Project in Sweden, in which care for complex patients is organised around their timetables, not those of doctors. This makes patients feel more in control and has reduced admissions. Nevertheless, the people who run Vanguard projects worry that they cannot transform care without overhauling how money flows through the health system. Budgets remain fragmented. Doctors face competing incentives. These are increasingly popular ways of organising health care in countries like America, Germany and Singapore.
In each case a single provider is responsible for all health care in its area. It is paid for outcomes, not activity. It is given a budget, adjusted for the health of the population. And so long as it meets its targets, it keeps the margin. Mr Stevens wants half of the NHS to use a version of the model by But Dan Northam Jones, a visiting fellow at Harvard, warns that the potential for savings is greater in systems like Medicare, where there is no cap on spending.
And yet ACOs reflect a growing belief that if you want radically to improve health care you have to change how you pay for it.ovepanac.tk
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They will not solve all the problems of the NHS, some of which are inherent in its taxpayer-funded model. But perhaps its business model may yet catch up with how illness is changing.
Significance and Opportunities for Emergency Medicine. The recently observed trends in global RTIs and fatalities demonstrate that current approaches to global road safety are falling short. A comprehensive injury prevention and control model is better suited to the task. To encourage action at all levels, it must be directed by those locally with influence within those same spheres.