Fragmentation is even more destructive than under-funding
The Guardian
July 16, 2003
The oldest and still the best
By Malcolm Dean
In the battle between 10 and 11 Downing Street over the NHS (National Health Service), Gordon Brown has always pushed two arguments for continuing with the current structure: first, that it is even more important today than its launch in 1948 because of its capacity to do so much more; second, because of the spiraling cost of modern medicine, which requires a comprehensive national insurance, such as the NHS, to provide the necessary protection.
If the chancellor had been at an international conference of leading policy makers last week, he would have learned a third reason: the advantages a national health system enjoys over federal or fragmented health systems.
…there are the new initiatives Labour has introduced nationwide: inspectors, systematic assessment of new drugs and equipment, new standards and a modernisation agency. They were described by Sheila Leatherman, an American researcher, who has been looking at their impact as “the most ambitious, comprehensive and intentionally-funded national initiative to improve health care quality in the world”.
But the initiative that generated the most jealousy was the new IT (Information Technology) system that will link all parts of the NHS for the first time: an extra £2.5bn over three years on top of the £2.4bn already planned. Currently there is no coordination among thousands of different systems. This will be a major step towards a crucial goal: better integration of primary care and hospital services.
The US has been trying to do this for years, but has been thwarted by its multiple systems, special interest hospital and insurance lobbies, and deeply fragmented services.
http://politics.guardian.co.uk/comment/story/0,9115,998723,00.html
Comment: It is remarkable what can be accomplished in an integrated system, even with very modest funding. The United States has proven that no amount of funding can correct the dysfunction of a fragmented system designed to meet the needs of special interests such as insurance companies.
Just imagine what 15.2% of the GDP, our current level of health care spending, could do in a universal, integrated, publicly administered system. But then, let’s not merely sit around and contemplate such an altruistic system. Let’s enact it.
(Note: There will be no Quote of the Day messages for the next two weeks while we are in Canada contemplating their altruistic system.)