by Helen Rainbow, Senior Health Researcher
The NHS performed badly in another international comparison last week when the Health Consumer Powerhouse Index 2008 placed the UK 13th in a list of the best European health systems. Media reaction focused on the fact that the UK lagged behind Eastern European countries such as Estonia, but in fact the UK could potentially learn a great deal from the type and pace of reform that is currently occurring in countries such as this.
I attended last week’s seminar in Brussels where the results were announced. What became clear was that the systems that were performing well in the face of growing demands were those that were prepared to make bold decisions with regards to healthcare reform. The overall winner of the index was the Netherlands, a country which introduced radical healthcare reform in 2006, involving a new model of healthcare funding – the model consists of a regulated private insurance system which incorporates a universal entitlement to healthcare.
It is noteworthy that the Eastern European countries which are improving their performance year on year in international comparisons are replicating key aspects of this model. These include the definition of patient rights and entitlements, and moves towards individual insurance-based funding systems. The Czech Republic is an example of a country currently undertaking this kind of reform.
In contrast, the UK and other Beveridge style health systems seem to be stagnating, and increasingly lack the ability to respond to growing demands. In particular the size and scale of the NHS machine makes it very difficult for it to keep pace with the world around it which is constantly changing. It is also interesting to note that continental systems heavily based on employee contributions are struggling as ageing populations impact the funding base.
While international comparisons are not foolproof and it is true the NHS continues to provide a good service to many of its patients these analyses raise a number of questions about its future. The funding question in particular is not going to go away, particularly in light of current events. We should watch with interest the developments in international health systems, and ask the question whether it is time for a more radical change in our own.
