Thursday, August 10, 2006


I found a great blog, by an American, Ezra Klien, which compares the healthcare in Japan, USA, France, UK and Canada. I'd urge everyone to read it (the conclusion is at the top of the blog, and the analysis of the health care of each individual country is beneath).

He concludes that the Americans should switch to the French system, which makes sense from an American point of view, as it costs less than the American one, while delivering better outcomes. Increasingly you hear Brits too, especially Tories, claim we should switch to the generous choice offered by the French system, while at the same time decrying without irony the "vast amounts" that Britain is spending on healthcare.

Britain is spending "vast amounts" only compared to the Tory years. Compared to other countries, we are cheap - we spend 8.3% of GDP compared to 10.5% of GDP in France (and 16.2% of GDP in the USA). And despite the extra expenditure in France, their health system is 10.9 billion euros in deficit. Makes our small deficit of £500 million look positively trivial.

The result of France's healthcare budget deficit is that while other countries are looking to emulate them, they are concluding that their healthcare is unsustainable and are looking to Britain's system of fierce cost control for answers. In 2004, the French government initiated some mild reforms moving the French away from it's pure choice system, where you could see whoever you wanted, whenever you wanted, to a British gate-keeper system, where you only see a consultant if your GP has referred you. They also introduced an ID card, the "Carte Vitale", to prevent abuse of the system, especially with regard to prescriptions. The Carte Vitale is linked to a database giving your entire medical history and expenses, which is designed to ensure that duplication does not take place. Huge protests accompanied these mild reforms, not least from people worried about the database and civil liberties.

Further reforms will follow. Many French felt that their expensive system was a failure when 15,000 elderly people in the care of the state died in the 2003 heatwave. They've also experienced occasional bed shortages, which came as a shock, considering how much they spend on healthcare.

Demographics will continue to move inexorably in the wrong direction, medical bills continue to climb, competition in places like the USA and France fails to deliver price cuts. As these pressures build, more and more countries will conclude that Britain's unglamourous but fierce centralised method of holding down costs by the weight of the dept of health is the only way to square the circle. This would have seemed absurd ten years ago, and some people are still in denial, arguing that it's possible to do what no nation has done - to have lower costs at the same time as having higher quality care and the latest medical technology. But in the end cost will be the priority. The public will always choose adequate care at relatively low cost over deluxe care at exorbitant cost. Especially in Britain, where they think that our meagre spend of 8.3% of GDP is "vast".

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