Competing successfully on a global stage is essential for any modern economy. The ability to do this is a result of a number of key factors, one of which is undoubtedly maintaining a healthy population.
At present, the signs in this area are not good, we are at the bottom of the international league table in comparison with other leading economies in terms of health outcomes.
This race is currently being won by the Swiss and Japanese health systems that perform top across health outcomes. These are followed by France, Germany, Australia and the Netherlands. Finally, the UK and the US lag behind. The UK performs very poorly against other countries on a number of key indicators including life expectancy infant mortality and cancer mortality.
Analysis in new report by Reform suggests that the best performing health services have two key characteristics – universal cover and the use of insurance incentives. Insurance incentives are responsible for achieving greater value and a focus on prevention. Most importantly, as a result of defining individual entitlements, they are capable of empowering service users by giving them real control over their healthcare. Universal cover ensures that the system remains equitable. It is important to note that the other poor performer, the US. makes good use of insurance incentives but lacks universal cover leading to poor overall health outcomes as many lack access to care.
The report proposes a new model of healthcare, a National Health Protection System, which draws on the successful elements of international systems while retaining the key strength of our current system, universality. The new system would see every individual spend a tax-funded premium of £2,000 per year (the amount the Government currently spends per head a year on the NHS) on a Health Protection Provider of their choice. Individuals would be able to choose who was responsible for looking after their health.
The model will lead to de-politicisation of the health service, with the role of government being transformed from a provider of services to a regulator. Other essential elements would be access to high quality information on health conditions and outcomes, and the development of a supplementary insurance market to cover rare drugs and luxury items.
The Government and the opposition parties have asserted their commitment to improving public health. For example Lord Darzi made it a major theme of his recent NHS review. This new model, would achieve this by re-orientating the service towards it’s customers, focusing on individual outcomes. As HPPs would be responsible for the costs of poor health, they would have an incentive to keep customers healthy. This could lead to encouraging good health through measures such as annual health checks and gym memberships as well as rebates for healthy living.
Because of the positive developments in the UK, this is a task of evolution rather than revolution which could be complete in three to five years. The key steps would be turning Primary Care Trusts (PCTs) into Health Protection Providers; allowing other insurers to join the system; and defining the core entitlement to healthcare.
The gains of healthcare reform are clear. 2.6 million people are on incapacity benefits in the UK. On a simple estimate, the gain to the economy of returning these lost workers to effective health and employment would be £80 billion, which would increase UK GDP by over five percentage points.
The overall conclusion of our report, is that for same price you can receive a much higher level of health care abroad. People in France and the Netherlands spend a similar amount on their health insurance and receive high quality comprehensive health services. If we are not able to do the same, we are forgoing a major competitive advantage.
It is time to look at the bigger picture in healthcare, and it is hoped that all three parties will pay this report close attention, consider its analysis and reflect on its conclusions. The ideas we present are a way of achieving the goal all governments seek to achieve, high quality, universal, healthcare.
Helen Rainbow is a Senior Researcher at Reform and co-author of the report.
The report Making the NHS the best insurance policy in the world is available at www.reform.co.uk.
