NO DIGNITY IN PUBLIC HEALTH SYSTEMS

An excellent post from the Adam Smith blog:

Britain's health system regulator, the Healthcare Commission, says that (thanks to an injection of tens of billions a year) the state-run National Health Service is now meeting lots of its targets, but is failing to treat taxpaying patients as customers. One figure I saw is that 25% of patients say they are treated 'as if they are not there'.

It is this, more than anything else, which defines the failure of state-run healthcare. Sure, when you look at the statistics, you find that some things the NHS does are actually very good, while others (like our performance on killer diseases like cancer and stroke) are pretty poor compared to other countries'. But what the statistics don't pick up is how people are treated as people.

A couple of years back I spent a good deal of time around one of Britain's 'flagship' hospitals, during the last illness of an elderly relative. Since then I've been determined never to set foot in the place again if I can help it. It was filthy, of course: one expects that. But the staff were also stressed out and frankly hadn't the time, or weren't well-managed enough, to handle their elderly patients with the dignity that any of us have a right to expect. There was no joined-up liaison with the family doctor, so my relative was not given an essential medicine, with disastrous results. She lost her wedding ring (very precious to her) but the ward had no system to deal with lost property. There was no plan to provide care for her when she went back home from the hospital. And so on. It was awful, and inhumane.

I don't believe that any amount of money will change this. Yes, it might mean that more women get breast screening or that family doctors can give you an appointment within the week. But it won't mean that patients are treated like valued customers, because in our system they are not. Only if we can devise a system in which the providers are paid solely on the basis of the patients' own choices will we ever do that.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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