NHS Reforms

Richard Hoey in the Health Care Blog on the latest iteration of reform of the NHS in England (reforms don’t apply to Scotland, Wales or N. Ireland). The system remains tax financed, with health care mostly free at the point of service, with a few exceptions, which has been the organizing principle of the system since its inception in 1947. The big reform ideas are:

….hugely controversial. Firstly, it abolishes a whole tier of NHS management and hands its powers instead to the family doctors at the frontline – the general practitioners, or GPs, as they are known here. Secondly, it loosens the constraints on the NHS’s internal market, providing scope for private companies to compete to run many more NHS services. The two reforms are intended to work together to drive efficiency across the health service, and the efficiencies required are pretty frightening – 4% a year for the next four years. (emphasis mine)

One of the knocks on the U.S. system of government is that it cannot make big changes like parliamentary systems can. The government in the U.K. is of course a parliamentary coalition between the Conservatives and Liberal Democrats, and due to shared power, no one got exactly what they wanted. As Hoey notes, that should sound familiar on this side of the Atlantic:

Just as with President Obama’s legislation, however, the real question will be whether it can achieve, in rather diluted form, what it was intended to do.

Dutch health reform

Hans Maarse with a post on the changes in the Dutch health care system in the Hastings Center blog. A few snippets:

The reform is intended to bring about a system of regulated competition in health care. The aim is to introduce competition while upholding fundamental social values, in particular solidarity in health care financing and universal access to health care. Another aim is to enhance consumer choice. Everyone has the right to switch insurance providers by the end of the year.

Is the health insurance reform a success? The answer depends on the perspective taken.

An interesting read with a longer paper on the Dutch reforms also by Hans Maarse here.

My take on what this means for the U.S. is that it shows that if you have a broad political agreement, then you can (inevitably) muddle through on the policy. Some things work better than others, but almost nothing works exactly as planned. There may well be some technical/policy lessons to be learned for the U.S. as far as how to incorporate private insurance into coverage expansions with a goal of increasing competition and choice, but what we most need is a political agreement about how to move ahead. When (if) we ever get that, we can work on the policy.