How can we boost funding for our NHS?
Growing demand, growing expense and a shrinking public purse. Exactly how could we ensure our NHS has the funding it needs?
The NHS budget is starting to feel like climate change – a massive, oncoming disaster that’s already hurting some and for which there appears to be no political solution.
In recent years the issue of NHS funding has almost never been out of the news.
Just this week the health policy charity and think tank The King’s Fund released a study claiming NHS managers are being asked to keep planned cuts secret – with little or no public consultation.
The NHS is currently being asked to find £22 billion of savings through ‘transformation’ plans and several NHS managers told the King’s Fund researchers that they had been asked to keep their plans for achieving this out of the public domain.
Campaign organisation 38 Degrees has warned that the planned cuts will involve the closure of accident and emergency departments, streamlining of maternity provision and a reduction in the number of hospital beds.
One thing that is clear is that we can’t go on like this, as Cameron said in his ‘I’ll cut the deficit, not the NHS’ poster back in 2010.
He’s not the first politician to promise a solution and he probably won’t be the last – we are living longer and our population is growing, so the pressure on our health service is inevitably growing too.
So what other ways are there to ensure the sustainability of this service that as a nation we take such pride in and reassurance from?
Here are a few. Do share your own ideas in the comments below.
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Raise taxes
A recent survey carried out for ITV News revealed that at least 70% of British people would happily pay an extra 1p in every pound if the money was guaranteed to go to the NHS.
Almost half of those surveyed said they would be willing to pay an extra 2p in every pound.
Office for National Statistics figures show that the current median average salary is £27,200 a year, which means people are willing to pay at least £272 more a year on average – not an insignificant amount.
Raising taxes is not normally a popular political move but some are gambling on the idea that the public will support raising extra funds for the NHS.
Liberal Democrat leader Tim Farron is one politician who believes the public will accept such a hike, telling his party’s autumn conference: “We need to face the hard truth that the NHS needs more money.
“A lot more money – not just to stop it lurching from crisis to crisis but so that it can meet the needs and the challenges it will face in the years ahead.
“If the only way to fund a health service that meets the needs of everyone is to raise taxes, Liberal Democrats will raise taxes.”
Of course, that’s not the only suggestion for closing the funding gap.
Charge patients a fee
One idea that’s been mooted a number of times is charging patients a small fee whenever they present for treatment – a bit like the current system for dental treatment in the UK.
There are many ways in which this could work but it’s often suggested that a £10 charge for visiting a GP would deter people from making unnecessary visits to their doctor or A&E.
Dr David Jones of Worthing Hospital believes this is the best way to raise money and limit demand from the ‘worried well’.
Writing in the British Medical Journal he said a £10 fee could raise billions to support the NHS as well as helping make savings by reducing the number of missed appointments, currently estimated to cost the NHS £162 million a year.
“They might also encourage patients to take more personal responsibility, leading to fewer people attending with conditions that they could manage themselves or that would be better managed through other primary care services (pharmacists, dentists, nurses, etc),” he said.
“This would lead to greater service availability and shorter waiting times in general practice.”
The Rand Health Insurance Experiment in the USA conducted 40 years ago certainly showed that user charges reduce demand for health care but not everyone thinks that would be a positive step.
Alan Maynard, Professor of Health Economics and Director of the York Health Policy Group in the Department of Health Sciences at the University of York, has expressed his concern that this can cost more in the long term.
“It is likely that such reductions in utilisation would delay NHS care and lead to subsequent increases in demand for support as patients’ health declined,” he warned.
Not only that, but patient charges are an additional tax on the ill – who may disproportionately be the elderly and long-term sick; people on fixed incomes who cannot work more to cover the cost.
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Pay a monthly subscription
An alternative spin on the £10 fee at point of use is a £10 monthly subscription, collected alongside council tax.
This has been suggested by Lord Warner, a former Labour health minister, who suggested this is the only way to ensure the NHS is sustainable in its current form.
The monthly fee would go on local, preventative health care.
In his report for the think tank Reform, he suggested that a £10 a month fee – with free membership for those already exempted from prescription charges – would raise more than £2 billion a year, without deterring people from seeking treatment.
Reform’s report also suggested ‘hotel charges’ for overnight hospital stays, full cost charges for holiday vaccinations and tougher ‘sin’ taxes on alcohol, tobacco and sugary foods.
However, the idea was criticised as being a flat tax that would hurt poorer people more.
The British Medical Association said it was “strongly opposed” to charging patients, arguing that an ‘NHS tax’ would be the start of a “slippery slope towards the end of an NHS that needs to be, and should be, free at the point of use”.
The Bismarck social insurance system
There are European models where social health insurance appears to work well.
For example, in Switzerland it is compulsory to have health insurance and there are a variety of providers.
The poor’s premiums are paid for on their behalf.
It’s known as the Bismarck system, compared to the UK’s Beveridge system, and relies on insurers who are independent of the health care providers – it’s the system used in the Netherlands and Germany as well as Switzerland.
Insurers are heavily regulated to ensure they do not decline applicants on the grounds of health conditions and insurers are not-for-profit but competitive.
A report, the Euro Health Consumer Index, ranks 37 countries on factors such as patient rights, waiting times, outcomes and access.
The Netherlands came first, followed by Switzerland and Germany came ninth.
The UK, excluding Scotland, came 14th, with Scotland coming two places below that.
“The Netherlands example seems to be driving home the big, final nail in the coffin of Beveridge health care systems, and the lesson is clear: remove politicians and other amateurs from operative decision making in what might well be the most complex industry on the face of the Earth: health care,” the report authors argued.
“Beveridge systems seem to be operational with good results only in small population countries such as Iceland, Denmark and Norway.”
The libertarian think tank Adam Smith Institute has reported that performance tends to be higher in countries following the Bismarck model compared to the Beveridge model.
“If Britain is going to reform its health system, it should stop tinkering with the NHS (i.e. trying to make socialism work) and ditch ‘Beveridge’ altogether,” commented Tom Clougherty, executive director at the think tank.
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Private health insurance
Few politicians have dared suggest that private health insurance should replace the NHS, although UKIP’s Nigel Farage suggested as much a year ago, only to be drowned in a wave of outrage from both the public and his party.
It can lead to some astonishing health outcomes – many pioneering treatments are perfected in the USA where the funds exist to develop them.
However, the downsides have been clearly documented.
Professor Maynard is scathing of the effectiveness of private insurance-based healthcare systems: “Insurance coverage typically involves part-payment by the patient i.e. co-payment.
“This has the same effect as charges, with additional costs associated with advertising among competing insurers and the need to recoup co-pays.
“Private insurance is funded by individuals and sometimes employers, with the financial burden [falling] on individuals’ income and the profits of employers.”
Not only that, but it is complex and expensive to administrate, meaning its budgetary demands are likely to inflate in a similar way to the NHS.
What would you do? If you have voted in our poll then please take a moment to explain why you made your choice using the comments below. Equally, please do share your view if you thought none of these options were suitable.
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