Market + Government Forces

The article outlines what seems to be the best idea which is also how the health care system in Switzerland works. Hospitals compete not for profit for patients. Even though health should not be left entirely to market forces, doesn't mean that market characteristics shouldn't be involved with the government run health care. As if inefficiencies of both forces are supplemented by one another. Competition lowers cost but government ensures moral responsibility and shared risk.

No Free Lunch

This article just highlights the idea that no system is perfect. The NHS has a very noble goal, which is the paternalistic idea of taking care of everyone, but it has encountered the fundamental flaw, which is that there is no free lunch. Medical care is expensive. Medical care continues to get more expensive, as more and more (expensive) technological advances come about.
In many ways, the NHS has the right idea, to focus on prevention and primary care, to provide incentives for prevention and to monitor new drugs/advances to keep care as cost effective as possible.
The NHS is not the only option for the British, people who want "extra" care can pay for it via (supplemental) private insurance. Maybe this option needs to be expanded, to take away some of the drain on the public system, much as private schools in this country take away some of the volume from the public school system.
Perhaps there should be a co-pay for drugs or some sort of deductible for the high volume users.
There is no such thing as free health care. The government is paying for it out of taxes, and the cost of the care continues to go up, out of proportion to inflation, the result is an unsustainable system, which is nice while it lasts. The only solution is to contain costs or raise revenue. Cost containment is already in effect through careful review of cost-effectiveness studies, but other options would be to limit proceudres/tests/drugs/access or abandoning the idea of 'free' universal health care (I don't think anyone is suggesting to go that far). The only other solution is to raise revenue, either by raising taxes, or introducing some variation of fee-for-service.
Ironic, but not surprising that this discussion continues in the UK, while we struggle with the opposite here.

4 years later...

It's interesting that this article warns of worsening financial problems for the NHS and hospital failures over the "next few years," however, it's been 4 years since this article was written and the NHS (and presumably hospitals) appears to be functioning quite well. It seems to reflect the thinking of the early 2000s when there was a lot of optimism about the private sector and a pervasive belief that private competition was a cure-all for a wide range of problems. I think attitudes have changed a lot since the financial meltdown. (For example, the idea of privatizing social security was quite popular at one point, but when people saw what happened to their 401ks last year, they're pretty happy government run social security is still around).

How are the hospitals doing now? The NHS does face its fair share of problems but it is still out-performing the US health care system overall. How would the NHS be different today if substantial market reforms had been implemented? Although financing and budget concerns are by no means trivial, it is necessary to separate the facts from doomsday predictions. All healthcare systems are facing rising costs, not just those with an NHS. So even if administrative costs and other waste is trimmed, the reality is that health care costs will continue to grow. The best that can be done is to slow that growth. However, it would be wise to examine the hospitals that are consuming greater resources and are at risk of failing since it seems to be implied in the article that some hospitals are performing better than others.

Where is the money going?

Coming from a country struggling to provide care and health insurance to all the citizens the UK system seems so amazing. I know that no systems are perfect, and any success comes with struggle, but it is disheartening to watch a system that many of us hold up as an example come close to crumbling.

I am not sure how going to a market based system will be beneficial based upon the information shared in the article. It would seem to me the further instability would be negative to an already struggling system. I believe that struggling or poor doctors should be pointed out, but in the interest of providing the citizens with the best possible health care wouldn't it be better to warn them and have these doctors improve their quality of care rather then create a system where no one will go to them and there will be greater issues with access to care.

I believe the UK needs to reevaluate their system, and see where money is not being spent wisely. Maybe like in the US there are high administrative overheads or perhaps paper processing is poor. Rather than simply throwing trusts at the system to cushion them until they fail, the UK should take a deeper look at such a valuable system.

What is the cause?

I agree with Teresa. National Health Services needs to figure out where exactly excess and unnecessary amounts of money are being spent. From what I have learned, the U.K has the right idea: access for all no matter what your preexisting conditions may be. This is a very noble ambition for any government to take on and I cannot even begin to imagine how hard it must be to insure that this system works. However, in order to further sustain this universal health care system, the government truly does need to determine where money is being used carelessly.

The article suggests creating lists of doctors that are known to provide good services. I do not quite understand what this would do to address the financial problem?

What is causing such a financial burden? Are there administrative costs that could be eliminated? Processing of paperwork that could be done differently to bring spending down?

must locate the problem first

NHS in the UK should take a step back and look at the inefficiencies of the current system and the possible adverse effects of the planned reforms. The King’s Fund stated the government’s reforms could worsen the financial deficits, but the Department of Health says these reforms could help address the problem. Where do the current inadequacies and inefficiencies lie? Before fixing the problems, they should locate the problem.

Dealing with hospital failure do put patients, as well as doctors, at risk for lower quality of care. The planned reforms want a market-based system for health care, which will only exacerbate the situation. If patients have a choice on where to go, doctors will be weeded out- that only the best doctors will survive, creating instability in the health care system. This means there is another solution to this problem. Why are hospitals failing? If it is not the patients, there must inefficiencies in the hospital itself- administration, services, etc. Looking at areas besides improving patient’s options, for example the infrastructure of the hospital, could lead to the real problem and possibly better solutions to solve the financial deficits.

Wasted Universal Coverage?

In the "King's Fund" article, the writer states that the NHS is in major deficit and all the possible current reform ideas will only increase the deficit. Like the US system, the UK must find all possible avenues of wasted or excess money. Since it is the hospitals that are feeling the greatest impact, the hospitals must obviously do a better job with their financial provisions. I'm not too sure what aspects are hindering the NHS system, but i'm guessing that there is money being wasted in hospital protocol and is in need of managerial discretion. I like the idea that the article mentioned about doctors being paid by performance. Good doctors will continue to be paid for providing good service, while the bad doctors will be weeded out. This sort of performance-based pay will motivate doctors to perform at their highest level of service. Although universal coverage would be ideal in the States, we don't need to add more deficit to our abyssmal debt.

Putting patients first can make you poor

In this article produced by The King's Fund, it is suggested that the deficit exists due to overspending caused by poor management, inefficient services, and waste. In 2006, nearly half of the extra funds in the NHS went to pay the increase in salaries for consultants, physicians, nurses, and other staff. Hospitals, according to the article, are in deep trouble because they have to decided between balancing the books or meeting patient waiting time expectations; under pressure, they choose to meet patient demands, which means they sink deeper and deeper into the red.

However, the solution probably isn't as simple as increasing patient waiting times (increasing rationing of services). Doing so would significantly decrease quality of health. As the article suggests, it may help to focus on budget management for a while, because administrators have pretty much been neglecting to control spending. I suppose increasing taxes is also an option? The British seem to overall be opposed to privatization, so using market competition to increase revenue wouldn't exactly work.

Though, I imagine the deficit will only get worse year after year now that London is gearing up to host the 2012 Olympic Games, which in and of itself is extremely costly.