I’m just going to highlight the Kings Fund findings but it’s worth reading the article in full if you ever have time/inclination.
Each of these ‘radical’ alternatives has its own strengths and weaknesses. They are all used in one form or another somewhere in the world – these are not theoretical concepts and they have been seen as appropriate for some countries. Given the current state of the NHS, should we consider using these alternatives in the English system?
There are four key reasons why this would not be advisable.
First, the cost of changing to a new model would be substantial, both in terms of the resources needed but also the opportunity cost. Take, for example, introducing a social insurance model, which is often proposed. As each country’s interpretation of this model differs, a design unique to England would need to be developed, legislated for and implemented, with a lengthy transition period if a new financial partnership between the individual and the state was required.
Second, in the long term, there is no evidencethat suggests any specific funding models routinely delivers a better health care systemthan any other. In fact, what tends to differentiate performance of health systems is the level of investment rather than underlying model of funding. This would suggest that a lengthy, costly and disruptive transition to social insurance is unlikely to deliver significant improvements in and of itself, without a corresponding increase in investment.
Third, self-pay and expanding charges would have ramifications for health inequalities for those unable to afford them and would also be unlikely to reduce pressure on the NHS. Furthermore, those who delay or avoid care due to cost could increase demand for expensive treatments, and this could also result in poorer health outcomes. All the different models still need a tax-funded safety net, and if this is not adequately funded and resourced there will be implications for health inequalities.
Finally, in the short term, there are significant challenges facing the NHS that these alternatives do not help to tackle. None of the alternatives proposed above would in and of themselves increase the capacity of the health care sector and so there would be no meaningful impact on improving access or reducing the backlogs of care more quickly. They would not result in more beds, diagnostics equipment, or improvements in the state of NHS buildings. Neither would they overcome the significant workforce challenges in the NHS, which require action to boost recruitment and retain existing staff. Likewise, to improve health outcomes requires action on both the quality of health care and also societal action on the wider determinants of health, which these alternatives do not guarantee.
England needs to improve both health and care delivery and health outcomes. Doing this requires additional investment particularly on capital (buildings and equipment), fundamental changes to social care funding and provision, a comprehensive approach to improving the wider determinants of health and governments adopting a long-term perspective to avoid repeating the mistakes of the past on issues such as workforce planning. None of the ‘radical’ alternative models would be an immediate or targeted solution to the challenges facing the NHS. In fact, each would bring their own drawbacks as well as benefits and introducing any of these would bring significant disruption. Tackling the challenges is better done through improving our current health care system rather than jumping ‘out of the frying pan and into the fire’.