NHS more productive than private healthcare


7:00 am - March 10th 2010

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Guest post by Richard blogger

Andrew Lansley has recently written about the main Conservative health policies. He justifies his policy to privatise parts of the NHS using the following statement about productivity:

“we can not go on seeing productivity fall in our public services, just as it rises in the private sector”

But if we look at productivity in healthcare, the NHS is actually more efficient than the private sector.

In healthcare all work carried out must be at the highest quality, and a much higher proportion of resources must be invested in quality in healthcare than in manufacturing. When it comes to productivity, public services present a problem because the outputs cannot usually be expressed in monetary terms.

The ONS get around this issue by measuring the change in productivity rather than the the absolute measure of productivity:

“the change in health care productivity is estimated by dividing the index of health care outputs by the index of health care inputs, using volume measures”

During the ten year period, 1997 – 2007, the output of the NHS has increased 52.5% (ONS). This is quite an impressive improvement, an annual average growth of 4.3%. The key figure, of course, is by how much the inputs have increased to achieve this figure. Over the period 1997-2007 the inputs increased by 59.3% (an annual average of 4.8%). ONS interpret this as a ten year fall in productivity of 4.3% in total or an annual average fall of 0.4%. This is the figure that Lansley is using when he says that there has been a “productivity fall in our public services”.

If we take the ONS figures at face value, 0.4% year-on-year fall in productivity is really not much. However, I would dispute that there is a real fall at all. The fact is, in 1997 the NHS was seriously underfunded and undermanned and had had two decades of underfunding. Consequently there was a need for a lot of capital expenditure and an increase in clinical staff. Things had got so bad that increases in capital expenditure and manpower were needed simply to stand still. In short, for the decade after 1997 the country was paying the cost of underfunding and mismanagement of the previous Conservative administrations.

In the period 1998-2008 there was an increase in the numbers of doctors of 37% and a rise in the number of nurses of 21%. When you look at it this way the increase in output (52.5% for 1997-2007) showed that output increased at a higher rate than the manpower input. That means a real increase in productivity. So considering the huge capital investments over the last decade, a productivity fall (using a measure that includes capital investment) of a mere 4.3% is quite remarkable. And if you exclude capital investment the productivity would be a year-on-year increase.

So what about the private sector, where is Lansley getting the “rises [of productivity] in the private sector”?

There are no published figures for the productivity of private healthcare in the UK since this is considered to be “commercially sensitive”. Instead, we have to look at other measures. The Healthcare Commission said in 2006 that private healthcare did not outperform the NHS in terms of quality. Anna Walker, the commission’s chief executive, said standards in the independent sector were “pretty much the same” as in the NHS.

So if the private sector are not providing better outcomes, then perhaps they are providing the same care as the NHS, but at a lower cost? To investigate whether the private sector can cut costs in treatment, let’s have a look at a case study.

A case study: Cataracts

Cataract surgery is straightforward and hence it is a good candidate for the private sector to bring in innovative, cost effective solutions.

NHS hospitals are paid according to the Payment by Results
national tariff. In effect this is the average cost of each procedure averaged for NHS hospitals in England. When a patient has a cataract operation the hospital will be paid the national tariff for the procedure. (The payment may be slightly more since the Department of Health applies what is known as the Market Forces Factor to the payment. This factor varies between 1 and 1.35 and is used to adjust the payment to reflect the difference in the costs across the country.) The current national tariff for “phacoemulsification cataract extraction and lens implant”, replacing a cataract, is £741 per eye.

So what about the private sector? Well, the first point to be made is that the NHS will implant a basic lens. If you choose to use private healthcare then you will be given the option of different lenses (for example to reduce UV, and even varifocal lenses) and some of these specialist lenses can significantly increase the costs of the procedure.

Therefore, when comparing costs with the NHS you should only look at the lower end of the range because this will be more equivalent to the NHS treatment.

The following is not a scientific analysis, but it should be representative. I performed a Google search for “cataract + cost” and came up with the following:

Advance Vision Care £2190
Ashtead Hospital £1550
BUPA £1800 – £2900
Capio £1650 – £2604
Cataract Care £1945
Cataractsurgery.co.uk £1300 – £1600
Consultants Eye Surgeons Partnership £1950 – £ 2500
harleystreetdirectory.com £1550 – £2950
Nuffield £1950 – £2600
Spire Healthcare Hospitals £1800 – £2900

This table is a mixture of actual quotes from surgeons, quotes from hospitals and clinics and general quotes from the large healthcare insurance companies. As you can see, the lowest quote is £1300, but the average cost is closer to £1800 or about 2 and a half times the NHS national tariff. Clearly the private sector has a lot of catching up to do to get to the productivity of the NHS!

Another example is the Mercury Healthcare Independent Sector Treatment Centre:

“In 2006, every cataract operation at the Mercury Healthcare ISTC at St Mary’s Hospital, Portsmouth, cost £5,590 compared to the standard NHS price of £847. The public has so far paid £335,412 for 60 cataract operations at the private-sector centre, since it opened on December 19 2005. The same number would cost £50,820 at an NHS hospital. Mercury Healthcare has an £84m, five-year contract, with local NHS commissioners. The contract states that Mercury should carry out 1,650 cataract operations a year, but the company gets paid whether patients are referred or not. The government also pays out an extra 20% to compensate Mercury for setting up the £10m centre.”

Furthermore, the British Medical Association say about ISTCs: “Every eight cases diverted to an Independent Sector treatment centre costs the taxpayer the equivalent of almost ten cases dealt with by the NHS”.

It is quite clear from the figures given above that the private sector is considerably more expensive than the NHS. Andrew Lansley may be right that productivity is increasing in the private sector, but it will need to have some very impressive improvements for it to reach the productivity of the NHS.

This is an excerpt, you can read Richard’s full analysis here

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Reader comments


I’m not overly concerned about how our NHS compares with our (greatly underused) private sector healthcare system in Britain.

What really worries me is how the NHS compares with healthcare systems in other west European countries which have so much better patient outcomes in terms of life expectancy, better cancer survival rates, lower infant mortality rates and so on. How did we get to a situation by 1997 where France had nearly twice as many physicians per head of population?

For comparisons between national healthcare systems in western Europe in terms of patient outcomes, try this from an independent Swedish think-tank:
http://www.healthpowerhouse.com/index.php?option=com_content&view=category&layout=blog&id=36&Itemid=55

I really don’t feel reassured to know that the NHS, with 1.3 million employees, is the largest single employer in all western Europe by far.

I’ll stick with private if that’s OK.
I don’t know if there are any private equivalents of Stafford, but I doubt it.

3. rob tennant

Don’t go crying to the state when disease-infected feral kids, denied state healthcare because they were told to go private but couldn’t afford it, come rampaging through your town on the hunt for precious medicine, cjcjc.

“I don’t know if there are any private equivalents of Stafford, but I doubt it.”

My official local hospital (John Major was born there in 1941) was officially designated the worst hospital in England in 2001 by the Health Improvement Commission: I joke not and can post links to press reports at the time. Since then, there had been a remarkable transformation after the old management was sacked.

An instructive insight: in the late 1990s, when Frank Dobson was health minister, my GP referred me to my official local hospital for some tests. I asked whether I could instead go to the nearest NHS hospital, which is about a mile closer to where I live and requires only one bus ride instead of two, since I don’t have a car.

No, I was told. That is no longer possible. I could only go to the official local hospital for the catchment area in which I lived.

As we came to learn, Frank Dobson regarded the notion of competition between healthcare providers as completely abhorrent.

@3 eh???

I’m not denying anything to anyone.

@4 – I’m being a bit thick, but the “official local hospital” was NHS too?

” . . denied state healthcare . . ”

By independent assessments, the citizens of other European countries mostly have better national healthcare systems when judged by patient outcomes.

The NHS is the “envy of the world”, indeed the rest of the world is so envious that none has dared copy it.

Yet, mysteriously, continental Europe is not ravaged by marauding bands of feral kids.
Nor, for that matter, is the US.

“@4 – I’m being a bit thick, but the “official local hospital” was NHS too?”

Oh yes, of course, hence “official”. According to Dobson’s decision as minister, we are supposed to go only to the NHS hospital in whose catchment area we live, regardless of whether that is the nearest or most convenient.

Both the closest hospitals to where I live in London are NHS trust hospitals. There is also an accessible private hospital within striking distance but I have no private healthcare insurance. Some friends who do, go there, at least they do if the cost comes within the annual limits of their private insurance cover. But most friends depend on the NHS for treatment and all of us are of an age where health concerns start to mount.

Btw the reason I monitor current news so closely and can post these many links to press reports is the direct result of participating in a local University of the Third Age group on Current Affairs since September 2001. And because I retired from the civil service in 1998, I’m familiar with many online sources of official data. Around the 2001 election, my PC was seriously hacked and I was driven off line for a month or so but can only speculate as to who was responsible. This is but one of many reasons why I’m a habitual floating voter and chose not to vote in the 2005 election.

Private healthcare can deal with simple stuff but if you get properly ill they’ll drop you like a hot potato.

On the other hand I hear from people in the NHS and private healthcare that a hip operation (for example) will cost the NHS less if they outsource it to private (as, apparently, the NHS is increasingly doing, which is good news for private in the present times) than if it is done in-house. Note that it will be the same operating surgeon.

Thats nonsense. Most private healthcare hospitals are attached to NHS hospital grounds and the consultants working in them are from the NHS hospital. Any tests that require equipment that is not available at the private clinic get carried out i the NHS hospital at a cost.

The reason you get higher costs is things like, private room, private bathroom, better food, far better nurse to patient ratio etc.

Note: my nonsense comment was in reference to the bullshit comment that “Private healthcare can deal with simple stuff but if you get properly ill they’ll drop you like a hot potato.”

As someone who’s other half is currently being treated for cancer, and has ha major surgery done in a private hospital as we have BUPA from work, the idea that private can;t deal with things is crap. The only thing private doesn’t do is A&E.

10
When the NHS was proposed, doctors were hostile to the idea of losing their freedom to practice privately. and becoming ‘employed’, was also seen as a loss of status. Eventually they were given massive concessions to bring them on board, usiing NHS facilities for private practice was one.
But when paying privately, what is forgotton, is that taxpayers are subsidiizing that particular procedure, no wonder that private procedures in NHS hospitals appear to be cheaper, the doctor does not have to pay for the expensive equipment.

Do private healthcare providers work in the same sectors as NHS healthcare providers?

If the Exchequer is maximising efficiency by providing only the most efficient services, then it seems obvious that the private providers will have to work in the less efficient or niche markets.

As an independent thesis, the higher cost of private services in the anecdote could reflect willingness to pay to avoid waiting lists. But we don’t know that because the author assumed that private and public services were exactly the same (“no apparent gain in quality”), so he assumed away the differences in waiting times and quality without actually investigating them.

I strongly suspect that we do not have enough information to say that either means of provision is more efficient, in the face of competing narratives. Perhaps the Tory spokesman is wrong in what he says, but it is hardly an argument against what he believes, at least not without heavier data.

This chart from the OECD Factbook 2009 shows that private spending on healthcare in Britain as a percentage of national GDP is relatively small compared with that in most other OECD countries:
http://titania.sourceoecd.org/vl=8150464/cl=43/nw=1/rpsv/factbook2009/10/02/01/10-02-01-g1.htm

The sensible and important policy issue in Britain is not public v private healthcare but about why other west European countries have better national healthcare systems in terms of patient care and yet manage to do so without creating a massive state-owned and run edifice like the NHS, the largest single employer in all western Europe.

In autumn 2008, John Humphrys, in the BBC Today programme, did an interview with Lord Professor Darzai, who had recently been appointed a government health minister.

Darzai – presumably relying on his DH departmental brief – came out with the standard line about the NHS being “the envy of the world”. Humphrys instantly jumped on that and cited the latest Health Powerhouse report showing that the NHS rated as fairly mediocre compared with healthcare systems in other west European countries. This is the 2009 edition:
http://www.healthpowerhouse.com/index.php?option=com_content&view=category&layout=blog&id=36&Itemid=55

Darzai didn’t really respond to that. Those of us who are fairly familiar with the accessible comparative data and briefings on national healthcare systems are getting more than a little fed up with all the propaganda being pumped out.

16. Truth Talker

I don’t know anything about how “productive” the NHS is, but our cancer survival rates are awful, some of the lowest in Europe, and far lower than evil, private health care in America. That’s because people with cancer typically spend more time on waiting lists in the UK.

But then, if it’s cheap for the government, who cares if people die on waiting lists?

Cancer survival rates may be better in the US, but we would need to know comparative costs to see whether the NHS was letting people down. US healthcare is very expensive, which is why Obama wants to rein in some of its excesses.

Its also worth considering how those better outcomes break down demographically. How many poor African-Americans die of their cancers compared with similar groups in the UK?

Steveb,

But when paying privately, what is forgotton, is that taxpayers are subsidiizing that particular procedure, no wonder that private procedures in NHS hospitals appear to be cheaper, the doctor does not have to pay for the expensive equipment.

My example was of the same operation carried out by the same surgeon in a private facility.

If you are correct perhaps the NHS ought to charge a fair price for the use of its facilities.

Also worth bearing in mind that healthcare expenditure beyond a certain level isn’t all that correlated to key things like life expectancy: http://www.marginalrevolution.com/marginalrevolution/2010/02/sweden-medicare-and-what-really-matters.html

In fact, advanced healthcare only plays a small role in extending life. There are two ways of looking at that. Either advanced healthcare is a luxury good of highly subjective value, and so can be safely left to a market, like a slightly efficacious version of homeopathy. OR: it is a massive waste of money whose costs should be stamped on (kinda like the NHS does) through monopsony provision, and forcing people to invest in more valuable things.

20. Truth Talker

“Cancer survival rates may be better in the US, but we would need to know comparative costs to see whether the NHS was letting people down. US healthcare is very expensive, which is why Obama wants to rein in some of its excesses.”

Expensive? In America you can get health insurance for as low as $56 per month. That’s not expensive. The only reason health insurance is expensive in some states is because of excessive government regulation.

The average yearly income in America is $46,000, compared to our $35,000. Plus Americans get to keep more of their salary (lower taxes). Plus everything is cheaper in America (no national VAT). Even if health insurance is more expensive in America, they have more money in their pockets to spend on health care then we do.

I love how the uber proponent of a free-market health care seems to be blithely ignoring the fact that profit should never be a part of healthcare, obviously he will not doubt struggle to grasp that and is blinkered to seeing the horrors of the awful, unequal terror that is the US healthcare system as a joyous utopia of fair treatment for all.

You think there should be profit in healthcare, I do not and it is on that fundamental core issue that the problem stands.

22. the a&e charge nurse

[1] “What really worries me is how the NHS compares with healthcare systems in other west European countries which have so much better patient outcomes in terms of life expectancy, better cancer survival rates, lower infant mortality rates and so on”.

And …….
[15] “Those of us who are fairly familiar with the accessible comparative data and briefings on national healthcare systems are getting more than a little fed up with all the propaganda being pumped out”.

This can only be regarded as “comparative data” in the loosest sense of the word, even the report authors admit on p27 (7);
“The first and most important consideration on how to treat the results is: with caution!
The Euro Health Consumer Index 2009 is an attempt at measuring and ranking the performance of healthcare provision from a consumer viewpoint.
The results definitely contain INFORMATION QUALITY PROBLEMS.
There is a shortage of pan-European, uniform set procedures for data gathering”.

If I was trying to compare hospital A with hospital B for management of heart attacks (say) but prefixed comparison with an admission that my results should be treated with ‘caution’, and that I was offering a ‘consumer viewpoint’ (rather than hard clinical data) and that I did not even have any reliable system of gathering data in the first place I would rightly be laughed out of the building.

Or lets say we were trying to compare A&E’s across Europe.
How on earth would you do that – by waiting times …….. when data is massaged to appease managers (allegedly) or the system is gamed to meet one target but at the cost of creating problems elsewhere?

Do you honestly think complex phenomena, like the sum of every individual’s treatment experience can be represented by an aggregate number?

Cancer is the condition that is usually cited when these comparative exercises are trotted out, but don’t forget cancer arises from over 200 different diseases and even if some patients in some countries did live slightly longer, are we simply talking about an extra few months with disseminated metastases? – if so it would be an accomplishment with mixed blessings.

For those interested in alternative assessments by Americans of the failings if their system of healthcare, an estimated 46 million Americans have no cover for healthcare costs and “The leading cause of personal bankruptcy in the United States is unpaid medical bills.”
http://www.newyorker.com/archive/2005/08/29/050829fa_fact

The American system is appalling. Public spending on healthcare as a percentage of America’s GDP is similar to that in Britain but Americans spend about as much again on private healthcare. For about 15% or so of America’s GDP, average life expectancy is marginally lower than in Britain and the infant mortality much higher.

The best examplars of healthcare for Britain are found among other west European countries, not the American system.

This news report on the World Health Organisation’s first ranking of national healthcare systems was in the Independent of 21 June 2000:

“The first attempt to rank the world’s health systems by how well they meet the needs of their populations has put the UK in a disappointing 18th place, behind France, Italy and other European nations. . . The US spends more than any other country on health as a proportion of its gross domestic product but ranks only 37th, below Chile, Morocco and Israel.”
http://www.independent.co.uk/life-style/health-and-families/health-news/unresponsive-nhs-ranked-18th-in-world-712332.html

24. Truth Talker

“I love how the uber proponent of a free-market health care seems to be blithely ignoring the fact that profit should never be a part of healthcare”

That’s not a fact, that’s an opinion. Why shouldn’t profit be part of healthcare, like it’s part of 60-70% of our economy?

Shit Talker:

And what you are pandering is not pure, partizan prejudiced nonsense about the free-market being the cure for all evils?

We differ hugely on solutions but you have no evidence and no rebuttal to the stack of evidence that points out how ineffectual and divisive private sector is for the healthcare system.

Go and find profit elsewhere, not in the weak the sick and the terminally ill.

26. the a&e charge nurse

[24] “Why shouldn’t profit be part of healthcare”.

Because there is ALREADY a mismatch between the demand for health care (which grows exponentially with every new drug and technology) and supply which as we all is know is constrained in a number of ways (bed availability, doctor to patient ratio, etc, etc) – so how can we justify diverting even more money away from patients and into the pockets of the already wealthy shareholders?

Simple question – can you produce ANY evidence that the private sector produces higher standards when we compare like for like, rather than the self-selecting, and relatively affluent group with a single pathology (usually) who use the likes of BUPA?

27. the a&e charge nurse

[24] incidentally, I think we have already established that Swedish think-tanks do not actually produce very much, if any, meaningful hard data [see 1, 15 + 22]

28. Truth Talker

“And what you are pandering is not pure, partizan prejudiced nonsense about the free-market being the cure for all evils?”

You obviously do not know what “partisan” means (heck, you don’t even know how to spell it!). I have not mentioned political parties at all, and that’s what partisan means.

“We differ hugely on solutions but you have no evidence and no rebuttal to the stack of evidence that points out how ineffectual and divisive private sector is for the healthcare system.”

Tell me, what about Britain’s top-down, monolithic, beaurocratic health care system pleases you?

Is it the high rate of death from heart problems?
Is it the low cancer survival rates?
The high waiting times?

European health care avoids these problems, because of market reforms. Please explain to me, then, how market reforms are bad.

29. Truth Talker

“Simple question – can you produce ANY evidence that the private sector produces higher standards when we compare like for like, rather than the self-selecting, and relatively affluent group with a single pathology (usually) who use the likes of BUPA?”

I can indeed:

Look at health care in the Netherlands. The WHO ranked them above us in health care quality and access – well, the Dutch system is as privatised as you can get. Private health insurance, private hospitals competing for profit – shock horror!

How about France, with it’s for-profit hospitals? Best health care in the world.

Germany, with it’s sickness funds which are operated independantly of the government? Better than the NHS by far.

Look at these three health care systems, then argue either:
a) They are not private (they are more private than the NHS)
b) They are not better (but the WHO disagrees)

Shite Talker:

It is perfectly acceptable to spell partizan with a z, also, as soon as you start attacking spelling (incorrectly, ouch, ego bruise and you don’t even know what it means), you’ve lost the argument because it shows you have little else to attack on.

You have offered no rebuttals at all to the detailed questions put to you on private sector healthcare at 23 and 26, you’re ducking because you don;t have anything aside from blind prejudice.

The Netherlands healthcare system is a public healthcare system, it is not a private one, it is also heavily regulated by the government and payments towards insurance are collected by the government, it is a long, long way off your free-market nonsense.

Same goes for France, their healthcare system is built on public money and government regulation and tight government controls, it is not a private sector healthcare system.

And Germany, that is the home of the world’s oldest universal healthcare system!

You can’t have your cake and eat it. You’re clutching at straws, using example of government run healthcare with some, heavily controlled elements of private sector investment as beacons of private sector working, when you can point to no private sector healthcare system that is not backed up, regulated and supported by public funds and works at the behest and control of the government.

32. the a&e charge nurse

[29] I suspect you may not fully understand the difficulty in obtaining reliable data for international comparison – I have highlighted x2 papers discussing these problems (see 59)
http://liberalconspiracy.org/2010/03/07/open-thread-tell-us-what-you-think/

For example you mention heart problems – would it surprise you to learn that the NHS is actually a world beater when it comes to management of heart attacks?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488784/

And when you say cancer – which cancer are you talking about?
Can you provide any meaningful data on the alleged differences?
As I mention elsewhere, cancer constitutes over 200 different diseases, are the Dutch, to cite one country you admire, better at managing all 200?

Of course France gets the usual name check, but have you ever tried to total up the HUGE differential in health spending over the last 40 years?
Comparing France to the NHS expenditure, expressed as a % of GDP for the following years is as follows;
1960 France = 4.2 (of GDP) ….. NHS = 3.9
1990 France = 8.9 ………………..NHS = 6.0
1998 France = 9.6 ………………..NHS = 6.9
http://content.healthaffairs.org/cgi/reprint/19/3/150.pdf

Needless to say France are still spending more on health to this very day (11% vs 8.4% in 2007)
http://stats.oecd.org/Index.aspx?DatasetCode=HEALTH

Penny starting to drop?
How can we begin to compare one system against other without WEIGHTING this sizeable historical difference in spend?
We are simply not comparing like with like – so how do we interpret complex health data, which is of variable quality to begin with?

@32: “Penny starting to drop?”

No – I think that denying the possibility of making valid comparisons between national healthcare systems is just another twist on the regular propaganda effort to whitewash the NHS regardless.

The greater longevity rates in most other west European countries, the lower infant mortality rates, the better cancer survival rates, the larger numbers of physicians per head of populations are all substantive reasons for considering the NHS is fairly mediocre in performance compared with healthcare services in other west European countries – as the Health Powerhouse, an independent Swedish think-tank, finds in its regular annual surveys.

And I seriously question whether public spending differences are the main explanation, partly because some west European countries are spending lower percentages of their national GDP on healthcare but also because of this recent news report:

“The National Health Service can make the £15bn to £20bn of savings needed during the next three years without damaging the quantity or quality of care – indeed while even improving the latter – according to David Nicholson, the NHS chief executive.”
http://www.ft.com/cms/s/0/6fba7dfe-e683-11de-98b1-00144feab49a.html

If £15bn to £20bn can be cut from the annual NHS budget of c. £105 billions without that making much difference to the quality of patient care, that doesn’t suggest to me that spending levels are the main constraint on getting better performance from the NHS. Besides that, we have this discomforting fact:

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

And this:

“Almost 4,000 NHS patients in England died last year following ‘safety incidents’, in which some aspect of their care went wrong. A further 7,500 patients suffered severe harm as a result of accidents or botched medical treatment.”
http://www.independent.co.uk/life-style/health-and-families/health-news/why-hospital-is-a-dangerous-place-to-be-1799083.html

34. the a&e charge nurse

[33] – rubbish, even the Swedes tell you themselves that their own data is hardly be trusted, while a couple of papers highlighted elsewhere [32] already testify to the inherent problems in such comparisons.

You haven’t commented, even once, on the historical difference in GDP when comparing the NHS to the big 3, France, Germany and Switzerland – how much cash over the last 40 years does this amount to?

It sounds like you are content to ignore such critical variables – now why is that?

“It sounds like you are content to ignore such critical variables – now why is that?”

I suggest you re-read CAREFULLY my post @33.

Some west European countries spend a smaller proportion of national GDP than does Britain – and I posted @15 above a (highly reputable) source for OECD data relating to national public and private spending in OECD countries on healthcare as percentages of national GDP. And those are the best comparative data going. Your claim that I’m trying to conceal spending data demonstrates that you either don’t understand the issues and data sources or that you are trying yet another propaganda smear of any NHS critic.

The CEO of the NHS has recently said that the annual NHS budget can be cut by 15 to 20% without that affecting patient care – evidently spending is therefore not a constraint on NHS performance – see the link @33.

You have still not accounted for the identified falling productivity in the NHS following the government’s splurge in spending on the NHS nor for the lamentable safety record of the NHS. Other media reports have said that about 10% of patients a year are harmed by NHS treatments

More spending on the NHS can – and has been – absorbed in higher staffing costs without corresponding increases in patient outcomes:

“”BRITISH doctors now earn more than their counterparts on the Continent, according to a new study. It has revealed that hospital consultants’ salaries increased by more than 30% between 2000 and 2004. British consultants and GPs are now better off than medical specialists in France, Germany and Denmark.”
http://www.timesonline.co.uk/tol/news/uk/health/article758105.ece

There is still the fundamental question about why no other west European country has sought to emulate the NHS by creating another massive state-owned edifice with a verging-on monopoly on the provision of national healthcare services. The fact is that Frank Dobson clamped down on competition on healthcare so I could no longer go to the nearest and most convenient NHS hospital for tests. How do all those other west European countries manage with competition between healthcare providers?

36. the a&e charge nurse

[35] “And those are the best comparative data going” – maybe, but even the best comparative data does not guarantee that the questions being raised here (once we begin to unpack the multitude of contextualising variables) are being fully addressed.
I am not saying that such data is pointless but it’s scope is somewhat limited, so must be interpreted bearing these constraints in mind.

“Your claim that I’m trying to conceal spending data demonstrates that you either don’t understand the issues and data sources or that you are trying yet another propaganda smear of any NHS critic” – no, I fear it is you that does not understand the issue, or at least you have remained silent on Powerhouse Charter (a source you have cited many times) after it was pointed out to you that even THEY acknowledged that their own data must be handled with ‘caution’ and that they had failed to develop a robust system of primary data collection.

In fact I have NEVER claimed the NHS is the optimum model of health care, this is purely an attribution made by you against me (calling me propagandist, etc).
Ironically you complain that I have not read your comments ‘carefully’, then accuse me of a position I have never put forward.

So let me spell it out for you.
International comparisons are nowhere near as straightforward as Swedish consumer groups would have you believe – you have never really been able to convince me that you fully understand why this should be so (I might be wrong, of course, but that is certainly my impression).
The NHS is being privatised by stealth – I think the country needs an open and honest discussion about these developments (and sometime before they shut down more A&Es or hand out yet another contract to a private provider).
If there is to be an alternative model lets try and find some robust evidence to support it, not to mention some degree of support from the patients who will actually using it.

37. Truth Talker

“The Netherlands healthcare system is a public healthcare system, it is not a private one, it is also heavily regulated by the government and payments towards insurance are collected by the government, it is a long, long way off your free-market nonsense.”

In the Netherlands, all insurance plans are owned and operated by private companies. So are the hospitals and clinics. It may not be totally free market, but it’s more free than our system, and their health care is better… QED.

“Same goes for France, their healthcare system is built on public money and government regulation and tight government controls, it is not a private sector healthcare system.”

You haven’t explained why the existence of for-profit hospitals in the mainstream system hasn’t caused poor people to be dying in the streets.

“And Germany, that is the home of the world’s oldest universal healthcare system!”

Cool, if you like Germany’s system, why not adopt it? ;) Don’t answer that, I already know why.

“You have offered no rebuttals at all to the detailed questions put to you on private sector healthcare at 23 and 26,”

There was no question put to me in Post 23. I have answered the question put to me in Post 26, by providing France’s for-profit hospitals, Germany’s competing sickness funds and the Netherlands’ private insurance and hospitals as evidence for privatisation being a good thing.

“you’ve lost the argument because it shows you have little else to attack on.”

Calling me Shite Talker was a supplementary attack then, I presume?

38. Just Visiting

Daniel Hoffmann-Gill

Calling someone ‘shit talker’ on a serious forum like LC is out of order.

I don’t care if your view was that they were talking rubbish – it was an abusive comment.

An apology is called for.

39. Sevillista

Interesting article.

I’m surprised that there is so little like-for-like comparison of private v public sector productivity.

The right-wing and Tories love to compare (flawed) public sector productivity data against the average for the private sector to say “Isn’t the public sector shit. Aren’t the workers lazy?” yet are unable to compare state schools with private schools or the NHS with private healthcare. Feels fairly meaningless to compare schools educating children with financial services or making widgets…

Several private sector industries e.g. construction have had productivity performance that is not as good as (the flawed and incomplete) public sector productivity stats. For those who are interested in measuring productivity and understanding the area (rather than making childish ideological points) a good ONS article is http://www.statistics.gov.uk/elmr/07_07/downloads/ELMR_July07_Goodridge.pdf

I note that there has been no attempt by right-wingers to challenge your estimates. Instead the argument seems to be that your findings are a special case as the public sector is definitionally inefficient.

Shite Talker:

Your ‘points’ have not only been dealt with by me but also, indirectly in there own discussion, the points of Bob B and the a & e charge nurse, like many of your ilk, your head is pretty firmly buried in the sand on this one, as you cling to personal political prejudice, which is cool but you’re doing so you’re only proving the lack of correlation between fact and your opinion.

You are trying to have your cake and eat it, using public health care systems that utilises, to a small degree, private service, which the government regulate and oversee to such high levels that it is only private in name but is rather a wing of the public healthcare program.

The fact that you have to pick out these elements in order to hold up your flagging point speaks volumes and as many, many others here have pointed out; in a universal healthcare system, profit has no place. You cannot point to 100% successful universal private healthcare systems because there are none because they quite simply would not work.

You are clutching at straws and shifting your argument to picking out small elements of private.

The truth of the matter is and I am not alone here in pointing this out, profit has no place in the health and wellbeing of a society’s citizens. Your blinkered desperation is just that and all you have been doing for some time here is re-iterating not debating; never mind ducking out of inconvenient rebuttals from numerous commentators here.

Just Visiting (if Only):

One down side of using pompous and ridiculous non de plumes to hide behind as you comment here anonymously, is that they are liable to be used against you. As are real names of course, the number of times people have made presumptuous personal attacks on me based on my name but I am not in need of running to mummy and calling for deletion or apologies. Shite Talker can man up or bugger off, as can you sir. And although you may share his free-market delusions, that doesn’t stop them being unworkable shite.

Oh and JV, leaving a comment in thread purely to point this out is a waste of everyone’s time, I hope this will be your last in this thread unless you have something on topic to say, otherwise it will be dragged off course by your ‘contribution’.


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    The NHS is more cost-effective than Bupa, yet Lansley wants to give these vultures more power. http://is.gd/u2nzo6

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