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One flavor of socialism just... got... marketyer.
April 3, 2008 11:50 AM   Subscribe

Britain's National Health Service has unveiled a plan that would allow citizens to choose where they are treated. I found that I had to refer to the NHS wiki page to refresh my understanding of the British system. The Telegraph has also published an interview with the Health Secretary and is inviting reader response.

Health care vouchers were the "next big idea" in 2005 according to the Washington Monthly (headline: "Solved!"). There are those who believe that a voucher-based system would be apropriate in the US.
posted by prefpara (8 comments total) 3 users marked this as a favorite

 
It will mean patients can shop around for care, arrange visits when they want, swap one type of treatment for another or buy their services from the voluntary and private sectors.

Oh, very nice, but the problem with plans like this it that they are based on the premise that large numbers of deadbeats are suddenly going to start behaving like rational economic actors.

I've spent time in NHS hospitals and didn't see too many rational economic actors. Quite the opposite. All the public wants is GOOD damn care in whichever hospital they happen to find themselves in. Placing the burden of selecting facilities on a bunch of meatheads in the guise of giving patients "more control" is a crock and a total abrogation of government responsibility.

It seems to me.
posted by three blind mice at 12:33 PM on April 3, 2008


It seems so to me too. Creeping marketisation - people in the main don't shop around for hospitals, they just go their local hospital.
posted by Mocata at 12:50 PM on April 3, 2008


What really got me about health care in the UK is that you have to register with a GP (on a list of GPs that are willing to take new patients) to get GP care. And you can't choose where the GP is, it is linked to your postcode. So, if I work across town, and want to register with a GP near my work rather than my home, I can't do that. It was explained to me that you need to be ergistered with a GP near your home in case they need to do a home visit. I politely explained that if I was so ill I couldn't make it to the GP's I would be calling an ambulance to take me to hospital, but this was not taken too well.

Where we are living now (in Australia) I can choose my GP. There are a few surgeries that won't take new patients, but in my case I just rock into the health centre in the city. If the GP I usually see is available I chose to book an appointment with her, but if I need to see someone ASAP I just go with who is available, my perogative. The system works well.
posted by Megami at 3:17 PM on April 3, 2008


Well, 3BM, I'm not so sure. In social care (home care for those too elderly or otherwise disabled to do everything themselves) the latest thing is individual budgets. Under this system, you don't put together a care package for a person and then deliver it - you cost it out, and then cut them a cheque. They can spend the money on getting Brenda next door to do the shopping, or down the pub if they want to: they are responsible for their own needs and they are provided with a cost-sheet of council- or privately-provided services if they want to use them. The results have been impressive - much much happier clients, reductions in services that people turned out not to want (like council-run day centres) and, in some cases, reductions in cost as well.
posted by athenian at 3:46 PM on April 3, 2008


This reminds me of something we have going on in Minnesota that has promised to inject more of marketplace efficiency into health care.

A company called Carol has arrived Minnesota, whose purpose is to allow consumers to compare prices for all sorts of medical procedures. Have strep throat? See which lab/doctor will do the strep test the cheapest etc... Their ad campaign is something like "you shop for everything else, why not health care services?"

I HATE this. No, I don't want to have to shop around. If something happens to my health I want to be able to go to the doctor, not sit down and comparison shop. If I am buying a car, then yes I want to test drive a few models and take my time to find the perfect deal. But I don't want to have to buy a Consumer Reports just to get an injury checked out. Furthermore, it just encourages people to go for the lowest bargain price and forgo developing a relationship with a primary physician. I don't want Wal-Mart health care.

In the end I find 'marketplace' solutions to just be incompatible with health care. The marketplace seeks to maximize profits, not my health.
posted by boubelium at 6:36 PM on April 3, 2008 [1 favorite]


This stuff is crap, they currently have a system called 'choose and book', I recently had to make a hospital appointment and they offered me 3 locations, the small hospital 1 mile from my house, the bigger hospital 12 miles from home or another place 25 miles away (and 1.5 hours by public transport). Guess which was the only one that had spaces when I called? After finally seeing someone they sent me for tests at the second facility. They've now offered me a 4th hospital to go to to get the results, its also 25 miles, 1.5 hours by public transport away. This is the same team of doctors working out of 4 facilities. The notion of choice is meaningless here, I just want to be able to get treated well and with some basic level of convenience, and I suspect that's what most patients want. I'm pretty well educated but how the hell am I supposed to make any kind of meaningful decision about what doctor to see at what hospital when I haven't even been diagnosed?

It worries me that the UK obsession with pseudo-market instruments has the potential for really screwing up our institutions. In my own field of renewable energy the choice of market based instruments has proved to be inefficient and more expensive than a non-competitive mechanism, and I wonder what the potential is for that to happen in other sectors. In health, you really have to wonder where those running the NHS look when they conclude that delivering health through a market is the best way.
posted by biffa at 2:40 AM on April 4, 2008


So, it sounds like the voucher scheme would only be for people with long-term illness of some kind (this link gives the example of people with diabetes and MS) and the elderly, which I guess is what athenian mentioned. Also, this is a reform to NHS England only, but correct me if I'm wrong.

I'm not too sure what this reform would mean. From what I've read it only relates to people who need long-term care of some sort, and in that case it's hard to say that they shouldn't be allowed choices about the treatment they have. BUT I'm leery of a voucher system which makes a patient a consumer. It also sounds like the NHS outsourcing to private care to some extent, which again to me just doesn't seem a good long-term solution to waiting lists, financial problems and so on.

The patient choice blurb also hangs around the related reform which allows patients to choose the hospital they'd like to be treated in. This sounds like a positive thing (more choice = more power to the patient = yay all round) but in practice I think this would be a pretty baffling choice to make (does everyone head for the place with the shortest waiting list?). I worry that it would add an extra bunch of work and complications for everyone involved, and the NHS is strained at the best of times.

(...possibly the most curmudgeonly thing I've written in a while)
posted by eponymouse at 2:46 AM on April 4, 2008


…in practice I think this would be a pretty baffling choice to make… I worry that it would add an extra bunch of work and complications for everyone involved…

Exactly.

This whole "patient choice" thing isn't new. I live in Nottingham, and my girlfriend needed to see a specialist last year at a hospital for a non-urgent (but nevertheless serious) problem. But you don't just get a referral from your GP and then go to the hospital. Your GP has to notify whatever Regional Bureaucratic Authority — by mail — that you have a Referral. Then the Authority notifies You, The Rational Economic Actor — by mail — that You Have a Choice, and which choice would you like to make? Please submit Form A to The Authority B — by mail — so that they can send you a form — by mail — for you to fill in and send — by mail — to book an appointment. And would you like Facility C, the local hospital that is a convenient distance away, or Facility D, the non-local hospital which is an inconvenient distance away. After that the facility will, of course, confirm your appointment — by mail.

The amount of paper and bureaucracy involved was comical and staggering. This is supposed to make health care better? All it does is increase cost, time and frustration.
posted by attaboy at 4:44 AM on April 4, 2008


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