BOOK
Universal Healthcare without the NHS: Towards a Patient-Centred Health System
Kristian Niemietz | John McTernan
(2016)
Additional Information
Book Details
Abstract
The National Health Service remains the sacred cow of British politics – any criticism is considered beyond the pale, guaranteed to trigger angry responses and accusations of bad faith. This book argues that the NHS should not be insulated from reasoned debate. In terms of health outcomes, it is one of the worst systems in the developed world, well behind those of other high-income countries. The NHS does achieve universal access to healthcare, but so do the health systems in every other developed country (with the exception of the US). Britain is far from being the only country where access to healthcare does not depend on an individual’s ability to pay. Author Kristian Niemietz draws on a wealth of international evidence to develop a vision for a universal healthcare system based on consumer sovereignty, freedom of choice, competition and pluralism. His roadmap for reform charts a path from the status quo to a more desirable and effective alternative.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Box 1\tA selection of titles | 24 | ||
| The author | x | ||
| Foreword | xi | ||
| Summary | xiv | ||
| Tables, figures and boxes | xviii | ||
| 1\tAn alternative history: what Britain would have been like without the NHS | 1 | ||
| In a universe not far from our own | 1 | ||
| Back to reality | 17 | ||
| 2\tWho should envy whom? NHS performance from an international perspective | 26 | ||
| Cancer | 27 | ||
| Stroke | 32 | ||
| Amenable mortality | 33 | ||
| Waiting times | 35 | ||
| The Commonwealth Fund study | 38 | ||
| Spending and efficiency | 45 | ||
| Robustness to demographic challenges | 51 | ||
| Choice and accountability | 54 | ||
| Conclusion | 59 | ||
| 3\tA quarter century of NHS reforms: what worked, what failed | 62 | ||
| The internal market of the 1990s | 64 | ||
| The period of ‘ultra-managerialism’ | 68 | ||
| The quasi-market reforms of the 2000s | 71 | ||
| Recent reforms | 85 | ||
| Conclusion | 87 | ||
| 4\tOther games in town | 90 | ||
| The NHS debate: insular and inward-looking | 90 | ||
| How social health insurance systems work | 94 | ||
| Notable features of the Dutch system | 101 | ||
| Notable features of the Swiss system | 107 | ||
| Notable features of the German system | 112 | ||
| Notable features of the Israeli system | 115 | ||
| Conclusion | 117 | ||
| 5\tTowards a pluralistic, sustainable healthcare system: a strategy for an orderly transition | 119 | ||
| The quasi-market: finishing the job | 119 | ||
| Free entry and exit | 122 | ||
| Free choice of Clinical Commissioning Group | 125 | ||
| The freedom to opt out of NHS commissioning | 128 | ||
| Vertical and horizontal integration | 130 | ||
| Freedom of choice over the depth and scope of coverage | 131 | ||
| Prefunding healthcare costs | 134 | ||
| Selective contracting | 136 | ||
| Conclusion | 137 | ||
| References | 141 | ||
| About the IEA | 152 | ||
| Table 1\tWaiting times for GP appointments and at A&E departments, 2014 | 36 | ||
| Table 2\tWaiting times for surgery and cancer therapy, 2014 | 37 | ||
| Table 3\tAccess to specialist care and waiting time for diagnostics | 38 | ||
| Table 4\tThe CF’s ranking for health outcomes (the ‘healthy lives’ category), 2014 | 39 | ||
| Table 5\tThe top five in the Commonwealth Fund study, 2004–14 | 45 | ||
| Table 6\tEfficiency reserves: potential gains in health outcomes through pure efficiency improvements | 47 | ||
| Table 7\tDegree of patient choice and private sector involvement | 55 | ||
| Table 8\tThe number of UK lives that could be saved if patients were treated in other countries’ healthcare systems | 93 | ||
| Table 9\tRisk structure compensation: a stylised example | 95 | ||
| Table 10\tEffect of Risk Structure Compensation Fund | 97 | ||
| Figure 1\tAge-adjusted breast cancer 5-year relative survival rates, diagnosed in 2008 or latest available year | 28 | ||
| Figure 2\tAge-adjusted prostate cancer 5-year relative survival rates, diagnosed 2005–9 | 29 | ||
| Figure 3\tAge-adjusted lung cancer 5-year relative survival rates, diagnosed 2005–9 | 30 | ||
| Figure 4\tAge-adjusted bowel cancer 5-year relative survival rates, diagnosed 2008 or latest available year | 30 | ||
| Figure 5\tMelanoma 5-year relative survival rates, diagnosed 2000–7 | 31 | ||
| Figure 6\tIschaemic stroke 30-day mortality rates (age/sex-standardised), 2014 or latest available year | 32 | ||
| Figure 7\tHaemorrhagic stroke 30-day mortality rate (age/sex-standardised), 2014 or latest available year | 33 | ||
| Figure 8\tAmenable mortality: standardised death rates per 100,000 inhabitants, 2012 or latest available year | 34 | ||
| Figure 9\tDrug consumption in the UK relative to a 14-country average | 42 | ||
| Figure 10\tHealth expenditure in high-income countries as a % of GDP, 2014 or latest available year | 49 | ||
| Figure 11\tHealthcare spending per capita by age, as a multiple of those aged 16–44 | 51 | ||
| Figure 12\tIschaemic stroke 30-day mortality rates (age/sex-standardised), 2000 (or first available year) – 2014 (or latest available year) | 61 | ||
| Figure 13\tPublic and private shares of hospital provision (% of hospital beds) | 91 | ||
| Figure 14\tAverage waiting times (number of days) for common surgical procedures, 2014 or latest available year: UK and Netherlands | 105 | ||
| Figure 15\tHow costs are shared in Switzerland: some hypothetical cases | 109 | ||
| Figure 16\tPremium-smoothing: a hypothetical example | 114 |