NHS

[Anorthernsoul 1221]

http://www.independent.co.uk/voices/how-the-nhs-is-being-dismantled-in-10-easy-steps-10474075.html

[Kid Dynamite 6055]

All part of the establishments plan. There's a lot of money to be made out of private healthcare. Keeping poor people alive doesn't even enter their head

[Park Life 70]

The NHS is a line in the sand tho? We'll see what England is made of.....Current thought is that it's political suicide to fuck with it...Not sure how much is going on by stealth.

[Kid Dynamite 6055]

Nah, apathy set in years ago for 90% of people. As long as they have big brother and X factor they're happy

[ChezGiven 0]

The article is in part gibberish. A National Health Service is defined like this: funded through taxation, free at the point of use, equity in access according to need.

 

However, the introduction of private companies into the provision of healthcare is a concern but in theory should not be. After the healthcare reforms of the early 90s, the role of the purchaser of healthcare services and the provider of the services was split. There were many competing concerns at the time, and a very influential and politically connected Economics Prof (Le Grand) from the LSE articulated the concerns best using Organisational Economic theory from the Chicago school (Williamson 1975 iirc). The basic analysis was about whether large complex organisations should be split up for efficiency reasons and the conclusions were clear. When an organisation like the NHS is split as per the reforms (the structure is still there today ans drives the current debate), the purchasers of services need to design complex contracts with the purchasers. The theory stated that when you have certain conditions (like we know exist in healthcare), the contracting process becomes v complex and to monitor them creates 'transaction costs'. These costs can be modeled and the eminent prof predicted that the transaction costs (admin, managers, finance directors - sound familiar?) of the Purchaser/Provider split would outweigh the benefits. I think the feeling remains within the NHS that this is the case but no one (to the best of my knowledge) has ever undertaken the analysis. How they would do that now is not that clear either.

 

Now we have come to accept the split and the structure. What this means is that we have purchasing groups making contracts with any providers based on historical contracts. So putting aside the potentially higher transactions costs of the new structure, i cant see how the financial and economic make-up of the provider organisation should impact the services purchased in the context of the contracts.

 

Its good to use an example. A provider supplies hip replacements (hypothetical). The purchaser (the CCGs who replaced the PCTs) has a population it looks after and last year they purchased 1000 hip replacements. The HRG Tariff for hip replacement is £1000 which gives the provider a 1m revenue. The purchaser has to monitor and maintain quality, so there are performance measures included in the contract which are based on outcomes, time spent recovering etc. They also need to account for the uncertain 'demand' for services, so there will a block clause (1000 ops) and an additional clause for less or more.

 

Now if the purchaser gets 1000 ops for 1m with a guarantee of quality - here is the controversial bit - then what is the cost to society? A privately run provider comes along and offers to do the same 1000 operations with the same performance measures, the same penalties, the same outcomes as measured contractually. However, they win the contract because they offer to do it for 950 per operation and to collect data to analyse long term trends in outcomes to understand how to improve performance. This is a better deal for the purchaser and patients.

 

The purchasers (who are NOT private ever in the new structure) are not going to accept worse conditions from private companies when they have incumbent suppliers. The private entrants have to compete with public incumbents and are upheld to the same contracts. The arguments against this happening are not based in economics or social political analysis, they are based on the notion that because an actor in the system made money privately, its not an NHS. See first sentence.