It's not how you think...
So I came at this thinking that the big differences would be markets versus command economies, the profit motive versus public sector ethos, dynamisms vs sclerosis (delete according to newspaper, I guess). But I'm rapidly discovering that the differences are more about roles played than the system.
Obviously there are systemic differences and hence entirely unique problems (uninsured populations vs waits for care, unintegrated systems vs local monopolies) but it is surprising how often you can analogise. For example pay for performance systems in the US - a way of incentivizing healthcare providers to provide care of higher quality - seem to push towards certain models of working. In many ways although the incentives are different the responses and theory of how this might work does not seem so different from the use of targets in the UK. In particular, both seem, from my admittedly rudimentary reading of P4P to be open to the criticism of focusing only on a subset of care, and potentially missing a bigger picture.
In contrast the players are really different. For example large corporations here are major purchasers of care (through purchasing health insurance for their staff) and certainly seem to use their power in health arena in terms of insisting on certain things. In contrast I'm less clear what the government's role is.
This has set me thinking as to whether there is a specific governemnt role in healthcare. By which I mean something uniquely governmental and outside of the healthcare system, as opposed to government playing system role (provider, purchaser, funder, regulator etc). Another question to speculate on over the coming year.
Obviously there are systemic differences and hence entirely unique problems (uninsured populations vs waits for care, unintegrated systems vs local monopolies) but it is surprising how often you can analogise. For example pay for performance systems in the US - a way of incentivizing healthcare providers to provide care of higher quality - seem to push towards certain models of working. In many ways although the incentives are different the responses and theory of how this might work does not seem so different from the use of targets in the UK. In particular, both seem, from my admittedly rudimentary reading of P4P to be open to the criticism of focusing only on a subset of care, and potentially missing a bigger picture.
In contrast the players are really different. For example large corporations here are major purchasers of care (through purchasing health insurance for their staff) and certainly seem to use their power in health arena in terms of insisting on certain things. In contrast I'm less clear what the government's role is.
This has set me thinking as to whether there is a specific governemnt role in healthcare. By which I mean something uniquely governmental and outside of the healthcare system, as opposed to government playing system role (provider, purchaser, funder, regulator etc). Another question to speculate on over the coming year.
posted by Exiled in mainstream at 5:36 PM
1 Comments:
What is government for? It is the representative of the people. There are many things that people can do for themselves as individuals, but other things that they do not have the expertise to do.
Experts set themselves up as service providers to fulfil these needs and Joe Public is at liberty to bargain with these providers to obtain these services. Sometimes he acts as an individual - shopping at Tesco, but he might also form a conglomerate with other purchasers to get a better deal.
A market is bound to develop whatever the service being offered, even if it means going abroad to purchase a particular item.
Someone has to regulate the market and this role has usually fallen on government (though not entirely; professional associations sometime succesfully regulate it.)
In health government's role is to protect Joe Public from a conspiracy of professionals. (And I include non-medical professionals in this - accountants, insurance companies etc).
In the NHS we have close to a monopoly supplier,which is never a good thing. The dead hand of bureaucracy rests upon monopolies. Things are never done quickly. Competition is necessary to chivvy the administrator. Remember when telephones were run by the Post Office.
There are specific areas that governement (or someone with the authority of government) needs to get involved. these are those where the wellbeing of the whole community is paramount despite being an inconvenience to individuals. The best exampole is defence of the realm, where conscription might need to be invoked despite an individual's dislike of violence. In health, the obvious examples are vaccination, clean water supply, quarantine, and various health and safety legislation.
Where government is paying for health care interference with personal freedom in the name of health and safety becomes more intrusive. Take legislation like wearing seat belts and crash helmets. If only theindividual is involved, why should governement care? But if governemnet is paying for repairing bodies after car crashes then it takes an interest. On the other hand drunk driving injures other people, so governemnet acts to limit it by law. Similarly, with smoking, it is only the passive smoking information that makes government act despite it being far more injurious to the health of the smoker.
So why should governement care about obesity? I suppose it is part of governement regulation of markets. Experts (the food producers) are rigging the market by lying to the public about how good for coco-pops are.
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