Sunday, October 01, 2006
Spending on health
This graph is referred to by my son's new 'work' blog. I find the figures quite surprising. In the UK in 1997 Tony Blair's warning was 90 days to save the NHS. It is certainly true that there has been a marked increase in spending on health, but after nearly 10 years the UK is still bottom of the heap as far as health spending is concerned.
Everybody has had to increase spending to keep up with what can be done.
A recent feature on BBC TV looked at the best public services in the world. For public transport they chose Portland, Oregon, but for health they chose Cuba. Astonishing! Cuba has no access to modern drugs and its health workers are paid a pittance. Nevertheless, life expectancy in Cuba is higher than in the US. Life expectancy in the US is an anomaly, probably the result of inadequate public health services for the poor. A high infant mortality impacts more significantly on life expectancy than excellent care for the elderly; an individual loses 70+ years rather than 3-4 years. So when the indigenous poor have next to no ante-natal care and when there are areas where the commonest cause of maternal death is gunshot wound, these impact far more heavily on the statistics than all the rituximab in the world.
All health care systems want to get the best value for money, but how you collect the statistics affects the result. Suppose the figures were collected not from cradle to grave but from conception to grave. What price Roe v Wade then?
Public health measures give you more bangs per buck than any other health intervention. Edward Jenner and John Snow had more impact than Harvey Cushing and William Osler. Of course, America has clean water and smallpox has been eliminated, but without full vaccination for children and good housing and nutrition for the poor, the acute health care system gets overrun by preventable disease.
I believe I saw somewhere that America spends more on Medicare and Medicaid and front-line free-care in the ERs of County Hospitals per head of population, than the UK spends on the whole NHS. What I am getting around to saying is that despite spending a far smaller proportion of the GDP on health, Britain spends it more efficiently than America. This is not done by impoverishing the physicians; British doctors are the second highest paid on the planet.
What I complain about in the NHS is the lack of freedom to individual clinicians. The bureaucrats have tried to turn medicine into painting by numbers. I once chaired an NHS committee that was trying to turn hematology into a protocol driven service that could be costed. They had done it for cholecystectomy, hernia repair and mastectomy. After 2 years of committee meetings I believe I had convinced them that it was impossible; patients were just too different. At least I convinced them that it was impossible with me as chairman, because the committee was disbanded, and I was never asked to chair another committee for the government.
The Conservative Party is holding its annual conference in Bournemouth this week. Their big new idea on health is 'Leave it to the professionals'.