Healthcare Reform the Under-Medicated Society:

Healthcare Reform

The under-medicated society: A proposal to facilitate new drug approval in Great Britain's National Health Service (NHS)

The National Health Service (NHS) of Great Britain is considered one of the premier models of state-provided healthcare in the world. 82% of the NHS is funded through taxation, while only 13% of its funding comes from employer-employee contributions and a meager 4% from direct user fees. "Unlike France, Britain's health care system is entirely separate from employment, and there is no distinction between its social insurance aspects (covering those who contribute) and its public assistance aspects (covering those who need it). The system simply takes care of everyone on British soil' (Klein 2009). However, there is also an allowance in Great Britain for those who want insurance along the lines of employer-provided models within the U.S., such as Britons who are willing to pay for additional coverage deemed unnecessary by the NHS public system, or Britons who do not wish to weather the long wait times for certain routine or specialized procedures through the NHS.

Private insurance and expanded and expedited care is possible because unlike Canada, Britain allows citizens to hold supplementary insurance. As well as NHS care, patients can opt for care for which either they or their private insurer (or a combination of both) must pay. 11% have some form of employer-provided or private insurance, and "many jobs offer it as a perk" (Klein 2009). "To accommodate this, doctors can have both private and public practices, meaning they can treat patients under public rules complete with queues for non-pressing procedures while, at the same time, be performing the same procedures with quick turnaround for those with supplementary private insurance" (Klein 2005). Unsurprisingly, this has caused a great deal of discontent about such apparent inequality in a system which, at least in spirit, is supposed to be based upon the principle of equal care for all. The tension because of the disparity of quality that exists between public and private care has only been exacerbated in recent years, as expensive and rare drugs and treatments that the NHS will not cover continue to proliferate. Thus, there has been a call for expanded access and coverage to such expensive and innovative care under the NHS -- even while funding has been cut.

The nature of the British system is to discourage, rather than encourage healthcare usage. "The NHS has a gatekeeper system in which every person who wants treatment must have a general practitioner (GP) as their primary care physician. Patients can choose their PCP, and even switch if they don't like their choice. The GP's get paid via a small monthly sum per patient (capitation), not adjusted for services rendered" (Klein 2005). Seeing specialists can be difficult under such a system -- moreover, GPs have an incentive not to treat patients even for primary care services, given that their fees are based upon numbers of patients who declare them as their GP, not upon the procedures they perform. The 'rationing' or cost-containment of the system lies in the fact that the GP has a disincentive to provide care, as he or she does not receive more money, whether he or she treats a chronically ill patient vs. A patient who does not seek any care at all. So long as the patient's name is on the roster, the GP is paid per head.

This system has created a very cost-efficient model for the UK: "the NHS is a remarkably frugal operation. Health expenditures in the UK accounted for 7.6% of GDP in 2002; in America, they were 14.6%, or almost double Britain's expenditure" (Klein 2005). However, this frugality means that bypass surgery, dialysis, and medications in general are much more rarely prescribed in the U.S. than in the UK. While there is frequent criticism that the U.S. is overmedicated as a society, the opposite is likely true in the UK. In other words, is unlikely that people are so much healthier in England vs. The U.S. To justify certain statistical disparities in care: the rate for coronary bypass surgery in the UK is 20% less than it is in the U.S.

To address the problems of under-medication, recently there has been a proposal to allow drug companies in the UK with "innovative" medicines to bypass the current screening process for cost-effectiveness, as a way of expanding care. The companies could sell the drugs to the NHS at a higher price than is customary "under a fast-track procedure to be proposed next week by the Office for Life Sciences (OLS)" (Bosley 2009). The NHS, because of cost as well as safety concerns, is highly reluctant to approve new drugs and grant them coverage. The British system blocks sales of expensive drugs to the NHS that it deems to be only of limited benefit, but patients with chronic and rare diseases have protested this policy -- as has the pharmaceutical industry. Patient advocates argue that the current method of drug approval and cost scale of the NHS denies patients life-saving drugs and makes pharmaceutical companies reluctant to launch new drugs in the UK because 25% of the global market is influenced by the UK price, and the UK market is so low-cost (Bosely 2009).