Embattled NHS can learn from other health systems around the world

http://www.theguardian.com/society/2015/oct/14/nhs-could-learn-from-other-health-systems-around-wold

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Today, only 40% of all countries globally provide their citizens with universal healthcare. The NHS offered inspiration to many countries when it established universal healthcare in 1948. Indeed, a national poll conducted at the Olympic Games in 2012 ranked the NHS as the institution that made people “most proud to be British”, beating even the Royal Family. I have never seen such a symbiotic relationship between a country’s health system and its national identity. It runs very deep and every politician knows it.

However, our continental neighbours can boast better health outcomes in some cases, such as cancer. Survival rates in England are around 10% lower than the EU average, particularly for colon, ovarian and lung tumours. We are catching up in some areas, including breast and stomach cancer but too many people are still being diagnosed too late.

Some European systems have a different way of financing, funding and providing healthcare. For example, Germany created the first social insurance sickness funds under Bismarck in 1883, which are still based on the principles of solidarity, subsidiarity and corporatism. Similarly, the widely admired French system is founded on the concept of “médecine libérale”, offering greater choice of doctor and clinical freedom. The Dutch are consistently lauded for patient focus, their system is based on the principles of both competition and social solidarity. Switzerland is similar and is the least distressed health service I have worked in. A case of “you get what you pay for”.

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But it’s glaringly obvious that these countries spend much more than the UK. We commit 9.1% of our GDP to health while Germany spends 11.3%, Switzerland 11.5%, France 11.7% and the Netherlands 12.9%. Having worked in 60 countries over the last six years, I’ve come to the conclusion that a single – or dominant – funder as in the UK offers our best hope for improved population health, patient care and taxpayer value. Germany and France have many health insurers, which pushes costs up. So does Japan, but the government sets a single price so, effectively, it is the dominant payer.

I returned to England from India only to learn that the NHS was already overspent by almost £1bn. Soon, there will be siren voices that either scorn the lack of efficiency in the NHS or question its long-term sustainability. Either position is too simplistic. We can make efficiencies, and also expect increased funding as the economy grows.

A single, or dominant, funder offers our best hope for improved population health, patient care and taxpayer

When it comes to cost-efficiency, there is plenty we can learn from other countries. Israel has a beefed-up primary care system which is fully enabled by an advanced IT infrastructure. It spends just 7.3% of its GDP for a population with an average life expectancy of 83 years. Singapore spends only 4.3% of its GDP on health on health for an average of 82 years because it couples personal responsibility for health with collective support. So, its government has just announced a $20,000 “housing grant” for families who want to live with or near their elderly parents so the family can take more responsibility for looking after its older people. Brazil deploys activist community health teams which pay as much attention to promotion as treatment while Japan took the brave political decision to introduce a compulsory long-term care insurance scheme for all those aged over 40 in order to combat its ageing crisis. While India has less to be proud of, some of its hospitals have taken innovative, cost-effective care to new levels by standardising clinical treatment plans, applying IT and maximising the skills of staff and carers so that care is provided at a fraction of the cost of developed countries.

I have come to the conclusion that there is no such thing as the perfect health system and that it certainly doesn’t reside in one country, but there are fantastic examples of great healthcare that can inspire us all to do better, especially if we cooperate and learn from each other.

Mark Britnell is chairman of KPMG’s Global Health Practice and author of In Search of the Perfect Health System, published by Palgrave Macmillan, priced £19.99