Map of life expectancy at birth from Global Education Project.

Tuesday, July 18, 2006

You go your way . . .

And we'll go ours?

The trend here in the US of A, of course, is to make people bear an increasing share of the cost for their health care, through higher copayments and deductibles. This is supposed to "empower" us by giving us "consumer directed health care."

It turns out that there has been a schedule of copayments for subjects of HRH Elizabeth II, by the Grace of God Queen, for 50 years -- who, unlike us, all benefit from the same health plan, the National Health Service. (Sort of like a universal, staff model HMO in our terms.) But now a parliamentary commission has taken a close look and decided that, on the whole, these co-pays do more harm than good.

International research has shown that health charges have a negative effect on health, and that patients with long-term illnesses suffer particularly when charges are in place. There is also some survey-based and anecdotal evidence which suggests that patients are less likely to visit their dentist or have prescriptions dispensed in full because of the costs.


The review should also consider a system of charges appropriate for future challenges. In the future, the NHS may not be able to pay for every possible medical treatment in a country with an ageing population, demographic pressures, rising public expectations and increased possibilities of medical treatment and long-term therapies. Some treatments or procedures may have to be charged for. The Government should consider this possibility sooner rather than later to ensure that a set of consistent criteria apply to those areas for which a fee is charged, to avoid the development of charges in an ad hoc way, as has been the case until now. With the introduction of such a system, it may be possible to abolish health charges which currently have a negative effect on health outcomes. The key principles that should be considered in this review are:

• services that are clinically necessary should be free;
• fees should not deter patients visiting their doctor or accessing healthcare; and
• any system chosen should be adaptable (to changing medical practice, treatments etc) and consistent.

Bottom line? They are proposing to go in exactly the opposite direction from the colonies, by abolishing most copays for ordinary, routine and preventive care; while considering (gasp!) rationing of expensive services that offer comparatively little benefit in relation to cost.

We aren't even having that latter discussion, even though the rising cost of Medicare is going to cause major fiscal problems in just a few years. How come Europeans are smart and we're stupid?

No comments: