As shadow health secretary Wes Streeting points out, UK health spending is also heavily skewed towards hospital care rather than social care and other community services, one of the main reasons why hospitals now unable to discharge patients and release beds and ambulances.
Says Streeting: “When the NHS is compared to other OECD systems, we are near the top of the chart for spending on hospitals and intensive care. But we are either at the bottom, or we are far behind in terms of our investment in primary care, social care, mental health, community services, diagnostics and capital investment.
“That offers the worst of all worlds…the challenge for the NHS is not simply a challenge of money. It is the best way to spend that money to get the best results.”
German ‘sickness funds’
It is not just greater capacity, more equitable spending and better population health that explains why other European healthcare systems are outperforming us. There are structural differences in the way health services are organized.
Control tends to be delegated more locally and patients can choose from a variety of providers. The role of the government is more limited and the great pillars of any modern health system (primary care, hospital care and social care) are better integrated.
In many countries, citizens also have a better idea of what they are paying for health, since their taxes or insurance contributions are mortgaged.
In Germany, for example, it is mandatory to pay into one of more than 100 different non-profit “sickness funds” for health and long-term care coverage. The rate is just under 20 percent of gross wages when you add them all up, and it’s split equally between employer and employee. In return, you are guaranteed comprehensive health and social care coverage, including mental health, dental, and long-term nursing care. Those who earn more than $68,000 can opt for fully substitute private health insurance.
“In theory, choice is one of the core strengths of the German healthcare system,” says Berlin-based reporter Jörg Luyken. “Doctors are generally self-employed, while patients are free to find doctors, hospitals, and health insurance providers that suit their needs.”
GPs must also survive on their own merits. You are not required to go to one to get an appointment with a specialist and you are not tied to a particular practice.
Luyken explains: “If you are looking for a consultation with an orthopedic surgeon in Berlin, you can choose from around 300 specialists online and have an appointment within a week.”
France has also long prided itself on its public health service, and it’s easy to draw favorable comparisons to the ailing NHS. When told that people who have suffered a stroke or other category two accident in England now wait on average more than 60 minutes for an ambulance to arrive, some French experts are surprised.
“Theoretically, you should be in the ER within 20 minutes and I would say that in 90% of cases, this limit is still respected when it comes to stroke or sepsis,” says Dr. Patrick Vogt, a GP in Mulhouse, east of France. “That’s partly because we have a network of firefighters who plug the gaps if the ambulances can’t get there fast enough and there’s a queue-jumping system when you arrive in those cases.”
As for GPs, Vogt says, “You can get an appointment within three to four days, an MRI within four to six weeks, and other scans within a fortnight.”
Ludovic Fournel, associate professor of thoracic surgery at the Cochin University Hospital in Paris, agrees that “looking at the UK figures, all health indicators are in the red.