Why Ration Health Care?: An International Study of the United Kingdom, France, Germany and Public Sector Health Care in the USA(8 Civil Society S.)

The National Health Service provides poor quality health care, compared with systems in other developed countries. In this book, Heinz Redwood makes detailed comparisons between the UK, France, Germany and the USA, in order to demonstrate just how wide the gap between Britain and the rest of the developed world has become. We spend less of our national wealth on health than countries at a similar level of economic development. In terms of numbers of doctors and nurses, the UK is closer to Mexico and Turkey than it is to France and Germany. As a result, we find ourselves denied the standard of care which people in other countries take for granted, or else we wait so long that some patients die before reaching the head of the queue. Although the solution to this problem is often assumed to be more government expenditure, Heinz Redwood shows that this may not be the whole answer. Whilst the UK government spends less per head of population on health than other Western states, the big gap is seen to be in private payment for health care. Because of the centralised structure of the NHS, with its almost total dependence on taxation for funding and abnormally low level of payments by patients, there is no opportunity to combine private insurance plans and co-payment with the system, as is the case elsewhere. As a result, healthcare in the UK lives in a storm-zone of its own creation. The problems are structural, and must be tackled at that level. Heinz Redwood argues that this will only be possible if we can break some taboos and ask why all care should be "free at the point of delivery", why there is no mix of public and private funds, and why patients have so little choice or control over their treatment. Other countries have achieved the ideal of the NHS - making sure that no sick person is denied care - without going down this route. Should dogma blind us to the lessons from overseas?

Table of Contents:
Summary. Part I Rationing and cost commitment: introduction; the r-word in healthcare politics; crossing the border; symptoms and tools- a spectrum of white, grey and black; when rationing is inevitable- the case of organ transplants. Part II International comparisons: health expenditure and resources; morbidity and outcomes; satisfaction and opinion surveys; The United Kingdom- a rationing climate; France- crisis in plenty; Germany- achtung! rationing alert!; The USA- the power to make choices. Part III TINA versus DORA: alternatives to healthcare rationing; options for the way ahead in the United Kingdom.