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Open the NHS and private pratice to real competiton

Comment 7th July 2010

Currently the NHS has an internal market which in real terms is meaningless. The only people making real profits are Doctors in private practice, who are able to charge exorbitant fees as local private facilities are almost exclusively staffed by local part time doctors who are also working in the local NHS. They have an effective local monoply. This is compounded by the 'guild status' of the various colleges, who control registration criteria, training and professional standing.

I believe government should be involved on all sides of the delivery of both NHS care and private care.

We pay National Insurance.This should be separated into 2 areas 1) Health and 2) Welfare benefit. This would allow defined rules to control; acces to health care. Those that have not paid into the system having much reduced access.(This would reduce abuse of the NHS by people coming as health care tourists) I would expect that government would wish to develope a 'premium' structure which would reflect ability to pay etc. Also I would expect premiums to be less for people with healthier life styles ie non smokers etc.

The law should state that all must have health insurance to a minimum standard, but not necessarily through the government scheme. This would open the, at the moment, restricted health insurance industry to a much greater population and hence inroduce new insurance providers resutling in inter insurance provider competition.

Everyone should be allowed to access any hospital provided the insurer is willing to pay the procedure costs. So privately insured individuals could acces government run hospitals at NHS prices, thereby bringing in real cash.

Government insured patients could also access private hospitals if the price were right. This would encourage private hospitals to fill service gaps. For example lack of MRI scanners, post myocardial infarct assessment etc. In fact any area where the NHS hospital is currently significantly failing.

NHS hospitals are already heavily paid for out of general taxation and there would be no need to alter this. Opening NHS hospitals to a significant number of  'private patients' would bring in real extra resources.

Private hospitals would rapidlly fill service gaps if they were allowed acces to NHS money. They would use employee doctors and so could offer a much more cost effect service than the current protected private sector.

Currenly it is normal for private patients to pay a private doctor £150 for an intial 20 minute consultation and it is not uncommen to pay £3000 for relatively minor proceedures. This is excessive profit which could be better used in both NHS and private sectors.

I could develope this theme further and show how the miriad of restrictive practices within the health care sector would be swept aside by the participation of government and citizen on both sides of the private/nhs divide. With a little reflection, once the holy cow status of the NHS is overcome, I am certain that others will think of more areas than I have detailed. 

Why does this matter?

Resourses within health care are currently being used ineffctively. The NHS has an unnecessarily complicated management structure which is supporting an artificial virtual market. There are restrictive practices within the NHS which mitigate against real change, whilst ensuring high incomes for medical personnel.

The private sector is making excessive profit. This is cash which could be used to improve the NHS, if the private sector were opened up to real competition


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