In his review of the report of the commission on the British National Health Service (NHS),1 Terrence Sullivan says that the United Kingdom spends a third less on health care than Canada but provides broader coverage. The coverage may indeed be broader, but it is spread a great deal thinner.
The NHS has been starved of money almost from its inception, and I am sure that Canadians would not accept the strictures imposed by spending a third less on their own health care system. Somehow, health care policy planners in Canada have felt that savings of this magnitude have been achieved in Britain by the panacea of capitation and salary as the payment options for physicians. This is not the case.
First, these savings have been achieved by avoiding necessary hospital upgrades. For example, until the early 1990s, the main referral hospital for the county of Somerset was still using Quonset huts for its wards. They were erected by the Americans in 1944, prior to the D-Day invasion.
Second, staff salaries were saved by employing foreign graduates, which robbed developing countries of the physicians and nurses they had used so much of their limited resources to train.
The third saving in the NHS involves rationing by death. By keeping elderly patients waiting many years for their operations, the NHS avoids a large percentage of hip replacements and other operations.
The commission that Sullivan reviewed sounds like the changing of the officers on the bridge after the Titanic has hit the iceberg. The NHS has tried everything from fund-holding practices to a Charter of Rights for patients, but it will remain a second-class service for most users unless it receives dramatically more funding. Unfortunately, this is unlikely to happen in an elitist society where efficient, fee-for-service private care is always available for the affluent.
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