Regina E. Herzlinger is the Nancy McPherson Professor at the Harvard Business School and the author of a new Bow Group paper on healthcare in the UK, Having it all in health care, How to achieve universal coverage, excellent care, and reasonable costs. She advised US Senator John McCain, currently advises other members of the US Congress and is the author of a number of books, the most recent of which was Who Killed Health Care? (McGraw Hill, 2007). Professor Herzlinger has been described by The Economist as "America's leading expert on consumer-orientated health reform" and this is the first time she has devoted a paper exclusively to healthcare reform in the UK.
63 years ago, Nye Bevan set out the fundamental principles of his proposed National Health Service, declaring that it was “intended... to generalise the best health advice and treatment" .
But it is increasingly clear that by international standards the NHS has faltered. Switzerland, a consumer-driven system, which subsidises individuals rather than institutions, delivers better and more equal outcomes. A 2007 Lancet article found male five year relative survival rates from all cancers at 44.3 in England and 53.6 in Switzerland. OECD data shows Switzerland outperforming the UK on most other outcome measures. Data on health inequality from an EU working group demonstrate that in England and Wales male manual labourers aged 45-59 are 44% more likely to die than their non-manual counterparts; the equivalent figure for Switzerland is 35%. Other sources tell the same story of the NHS delivering more unequal outcomes than the consumer-driven Swiss model.
However noble its intentions - as my Bow Group paper published today shows - the NHS fails to maximise equity and quality for fundamental structural reasons, which only truly consumer-driven reform will address. It fails essentially because two types of patient choice are needed: choice of provider and choice of insurer. Opinion in Britain has certainly shifted towards the former over the last decade. But results comparable with Switzerland will not be achieved as long as 61 million people all get the same state monopoly insurer, whether they like it or not.