Comment / Positive thinking

Several months ago I wrote about watching the Michael Moore movie Sicko while staying in the US for the American HFMA Conference. The movie looks at the US system and contrasts it with our own, the Canadian, French and Cuban systems. It’s a bit of a ‘shockumentary’, using slick editing to downplay the US system while promoting the benefits of universal healthcare. Subsequently, I was asked to write an article for the US association’s hfm magazine and followed this with a conference address on the pros and cons of the UK health system.

I have to admit I scratched my head at first. All too often we look at the minutiae of UK healthcare policy, rather than defending or promoting the system as a whole. This is not a case of whether we like payment by results or not, but more a question about whether we want universal free healthcare. The concept of the NHS is so embedded in our psyche that any major shift in policy towards, say, an American system is unlikely, despite the spiralling cost of looking after an ageing population.

An example of this has been the desire of devolved nations to embed the ‘free’ culture by abolishing prescription charges in Wales and introducing free nursing care for elderly people in Scotland. Changing the way services are provided is tough enough. For any party in the UK, a call to abolish the NHS would be political suicide.

Of course, the key benefit of the NHS is the peace of mind the individual citizen derives from being covered. But there are other benefits relating, for instance, to the discipline of working within a fixed financial envelope and economies of scale and planning. There are advantages in having a single staff and managing a system in which the players work together.

I had more problems deciding what the cons of the system were. I would have said waiting lists a few years ago, but the progress being made across the UK has been impressive. Of course, there will always be headlines about individual incidents, but these are mercifully few. My sense is that there is a real momentum to develop the NHS into a world-class service.

The biggest disadvantage of our system is its tendency to be used as a political football. While there is broad political agreement about the nature of the healthcare system, closures or relocation of individual frontline facilities are usually roundly opposed by all political sides, often making it difficult for services to evolve in line with technology, new clinical practices and changing demand. The problem with a state-provided system has been the tendency for those in power to seek service improvement through the blunt tool of structural reorganisation

However, the pros far outweigh the cons. I’m convinced that if the US were to develop a healthcare system from scratch, it would more closely resemble the NHS than to its own insurance-based system.

Contact the HFMA chief executive on [email protected]