Posts Tagged ‘Patient choice’

Coalition government unveils health policies

By Mike Broad - 24th May 2010 10:13 am

The coalition government has published its plans for the NHS, merging the policy commitments of the two parties.

The document, called The coalition: our plans for government, re-iterates the Tories commitment to marketisation of the NHS, giving patients more choice of health provider, and cutting administration costs.

It also supports the formation of an independent NHS board overseeing aspects of the NHS. And further development of NICE, and the regulators the Care Quality Commission and Monitor. 

The commitments include:

• Raising quality through much greater involvement of independent and voluntary providers.

• Giving every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices.

• Publishing detailed data about the performance of healthcare providers online, “so everyone will know who is providing a good service and who is falling behind”.

• Putting patients “in charge of making decisions” about their care, including control of their health records.

• Creating a Cancer Drugs Fund to enable patients to access the cancer drugs their doctors think will help them, paid for using money saved by the NHS through the pledge to stop the rise in employer National Insurance contributions from April 2011.

• Reforming NICE and move to a system of value-based pricing, “so that all patients can access the drugs and treatments their doctors think they need”.

• Prioritising dementia research within the health research and development budget.

• Stopping foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests.

• Giving front-line staff “more control of their working environment”.

• Establishing an independent NHS board to allocate resources and provide commissioning guidelines.

There are also significant commitments in primary care including the renegotiation of the GP contract with a view to getting GPs more involved in out-of-hours care, scrapping practice boundaries and having PCT boards partly constituted by directly elected members.

At the document launch, David Cameron said coalition health policy was “more radical, more de-centralising” than either party had planned.

Commenting on the plans, BMA chairman, Dr Hamish Meldrum, said: “Doctors want to work constructively with the new government and we are pleased that today’s plans prioritise clinical engagement with the medical profession - it is essential that this dialogue is meaningful and does not just pay lip-service to the notion of involving clinicians in proposals for the health service.

“Despite some reassurances about funding, the NHS faces a challenging time ahead with considerable funding pressures and any plans the government has to make for efficiency savings should be based on clear clinical evidence and involve doctors at all levels to ensure that quality of care for patients is protected.”

The BMA wants to see more detail before commenting on specific policies.

Dr Jennifer Dixon, director of thinktank Nuffield Trust, said: “We welcome moves to provide a stronger voice for local communities on the boards of local PCT. But much-needed changes to local health services, particularly those that reduce avoidable and costly care delivered in hospitals, must not be derailed because they are unpopular. Too much care is delivered in hospitals when it could be prevented and we now need radical changes to the way patient care is commissioned, organised and delivered outside hospitals.”

Read a full list of the commitments.

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What has been the impact of the market in the NHS?

By Mike Broad - 9th March 2010 10:04 am

A new study, by think tank Civitas, has questioned the achievements of NHS reforms in introducing competition and driving performance.

NHS ‘internal’ or ‘quasi’ market policies in England have aimed to promote competition among providers in the hope of replicating the benefits markets have been known to bring about in the private sector: decreases in cost, and increases in efficiency, quality, innovation, and provider responsiveness.

In 2002, the government introduced a new round of market-based reform within the NHS, which was initially focused on increasing choice for patients, decreasing waiting times, and improving quality of care.

Demand-side changes saw the creation of the primary care trust to perform a purchasing role similar to that of health authorities; and practice-based commissioning, a re-incarnation of GP fundholding but focused on community-based and specialty services rather than elective care. Patients were also given a choice of elective care provider (including non-NHS providers) at the time of referral.

Supply-side changes included the introduction of quasi-autonomous foundation trusts, and the encouragement of provider plurality. Market-based changes to the secondary care payment system took the form of payment by results (PBR).

The study, called The impact of the NHS market, involved a large-scale literature search on the effectiveness of these policies.

So how have the reforms worked? A summary

Patient choice studies show the percentage of patients who recall being offered a choice of hospital for their first outpatient appointment was 47% in March 2009, up from 46% in December 2008 and 30% in June 2006.

Eighty nine percent of patients offered a choice are able to go to the hospital they choose. Choice has contributed to decrease waiting times for elective surgery. There is disagreement among researchers on whether choice has had a positive or negative effect on equity. Fear of the impact of patient choice (rather than actual impacts of patient choice) has led some NHS providers to advertise services to both patients and GPs. In practice, the uptake of choice policy is not yet widely realised, and degree of implementation varies geographically.

The Choose and Book system may not be enabling as much choice as expected regarding appointment date and time and number of providers offered; GPs may use the system as an online tool to make referrals as usual. Patients and GPs desire more information on provider quality.

Neither strong theoretical nor empirical support exists on the benefits of secondary care provider competition; studies exist citing both improved and harmful outcomes.

Contestability, or the threat of competition, may be driving up efficiency but at the expense of inter-professional and inter-organisational collaboration. Competition is fostering development of more business-like cultures in NHS hospitals. Various impacts of competition policy have been seen on health economies, such as attraction of top quality nursing staff to private providers, confusion of PCTs and NHS providers over the nature of their relationships, and resentment among medical professionals toward local ISTCs regarding lack of patient treatment data.

ISTCs provide equal if not better outcomes than NHS providers, and receive higher levels of patient satisfaction; however, they treat a healthier case-mix of patients than NHS providers (as was intended by their contracts). ISTCs may have negative effects on NHS surgical training.

Increased autonomy over certain governance and finance decisions may not currently be a strong enough incentive to encourage further applications for foundation trust status. Many lay governors and directors of foundation trusts are finding their roles ambiguous and difficult to define. Many perceive that they have made little impact on the decisions of the trusts to date.

However, evidence does show gradual increased involvement of both governors and the public in their activities. Foundation trusts have generally performed well financially and have generated surpluses; and they have been high performers in routine NHS financial and quality measures when compared to NHS trusts.

Surpluses have, however, been modest in relation to total revenue; and many were among the highest performing NHS trusts even before status conversion. Little robust evidence exists to suggest foundation trusts are using their new status to innovate in a significant way.

Payment by Results has been fully embedded across the NHS since 2008. Unit costs fell quicker in hospitals once PbR was implemented, although administration costs increased. Hospital activity increased as PbR was implemented. No association has been found between PbR and quality of care. Where increases in efficiency were found post 2002 (for example, the increase in number of elective surgery patients treated as day cases, decrease in the length of inpatient stays, and reductions in avoidable admissions), authors note other policies and trends have also encouraged such results.

Many hospitals have improved financial management and have a better understanding of patient costs since PbR implementation, yet a substantial agenda of cost improvement remains for the NHS. Mixed evidence exists on prevalence of hospitals ‘upcoding’ procedures in order to get paid more.

The fact that the PbR tariff for a procedure is set at average cost encourages hospitals to become ‘average’ rather than aiming to operate at the level of the most efficient hospitals. Being paid per case through PbR produces adverse incentives for hospitals to increase activity beyond affordable levels and possibly induce demand inappropriately.

Practice-based commissioning implementation is slowly advancing. It is being led by a few enthusiastic practices working with supportive PCTs. Variation exists in the quality of local relationships and levels of PCT support; with resources and experience often limited at both PBC and PCT level. Incentives and infrastructure used to support PBC are not sufficient to engage most GPs in commissioning. And many PBC consortia are more interested in self-provision than commissioning new services.

PCTs lack the necessary skills to purchase effectively; poor local management of resources was noted. PCTs do not always take full advantage of their potential power in the purchaser/provider relationship. Only weak incentives exist for PCT managers to break historical patterns of purchasing. The World Class Commissioning programme is too new for its impact to be determined.

In conclusion

Many researchers found difficulty in attributing improvements specifically to market-based reform. Improvements in NHS care, such as major reductions in waiting times, have more often been attributed to ‘targets and terror’ together with increased spending, than to competition. Lack of a stable policy environment de-motivates staff. As yet, there is a lack of patient and public understanding and support for market-based reform. And many desired outcomes have not yet been achieved, such as innovative models of patient care.

Although there are presently very few studies that evaluate the cumulative effects of market reform, there is an abundance of research on the effect of individual policies. While evidence on the impact on quality of care is mixed, research has found attributable impacts in the form of reduced waiting times, improved access for patients, and increased provider efficiency.

However, potential confounding factors (such as simultaneous increases in funding and pressure from enforced targets), along with weak monitoring strategies, make attribution to market policies alone questionable.

The market reforms of the past 20 years have had unmistakable effects on the culture of the NHS. In particular, the introduction of competition has developed a system-wide awareness of costs, efficiency and accountability. However, the reforms have not been proven to bring about the beneficial outcomes that classical economic theory predicts of markets, including provider responsiveness to patients and purchasers; large-scale cost reduction; and innovation in service provision.

Many researchers have attributed this to the failure to create a true, functioning market, as well as a lack of a stable policy environment to inspire staff commitment and enthusiasm. The available research indicates that the NHS may have found itself in a lose-lose situation - having taken on the extra costs of competition without experiencing the benefits.

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“Funds to stimulate competition being wasted”

By Mike Broad - 4th March 2010 6:22 pm

NHS reforms are failing to deliver widespread benefits, research reveals.

A study by think tank Civitas suggests that efforts to establish market forces within the NHS have been compromised by continuing centralised control.

On the plus side, reforms have led to improved access for patients, reduced waiting times and improved financial management. But, it claims the benefits are not widespread with weak commissioning, low levels of innovation, and poor professional and organisational collaboration.

Report author Laura Brereton said: “While there have been improvements, they are not clearly attributable to market based reforms. The NHS appears to be in the unfortunate position of taking on the extra costs of competition without realising the benefits.”

The report says patient choice has contributed to reducing waiting times but the uptake of choice is not widespread. The Choose and Book system on which it relies is restrictive, it says, and the quality of information on providers available to patients is weak.

It claims that the threat of competition has driven efficiency in some places. Quality of care, including patient satisfaction, is often seen to be better in new entrants such as privately run ISTCs. But competition has led to confusion over the relationship between commissioners and providers and made collaboration more difficult.

Foundation trusts have performed well financially and on routine quality measures, it says. But they were the best performing hospitals before their change in status and there is little evidence to suggest they’re more innovative.

Payment by results coincided with an increase in activity and efficiency, improved financial management and a decrease in unit costs. But the report says the setting of the tariff at the ‘average cost’ encourages providers to be average. Hospitals are also incentivised to induce demand inappropriately.

Problems are also highlighted with commissioning, particularly among PCTs which are accused of lacking the necessary skills to drive performance and purchase effectively.

James Gubb, director of the health unit at Civitas, said: “While the NHS is better than it was in 2002, wavering commitment to the idea of a market has unquestionably stymied the impact it could have had.”  

Read the full report.

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The Conservatives’ health manifesto: at-a-glance

By Mike Broad - 7th January 2010 12:43 pm

The New Year has brought the opening salvos of the general election campaign, which is expected to be held in May.

This week, the Conservatives published the first chapter of its draft manifesto - on health. They’re going to publish it chapter by chapter and are calling it a draft because they say they want public response before finalising it. 

The manifesto starts by making a commitment to keeping healthcare free at the point of use and available to everyone based on need not ability to pay.

The Tories claim that despite a massive increase in spending on the NHS, the gap in health outcomes between the UK and the rest of Europe has widened. They also accuse Labour of top-down, bureaucratic mismanagement that has undermined NHS staff and skewed priorities.

They’ve pledged to protect health spending and claim their reforms will be based on decentralisation, accountability and transparency.

A patient-centred NHS

1. The Conservatives have pledged to scrap all of the politically motivated process targets.

2. Make detailed data about the performance of trusts, hospitals, GPs and other staff available to the public online.

3. Put a focus on health results, particularly cancer and stroke survival rates and reducing infections.

4. Enable patients to rate hospitals and doctors according to the quality of care.

5. Enable patients to choose any healthcare provider than meets NHS standards.

6. Put patients in charge of their own health records, with the ability to choose which providers they share them with.

7. Open up NHS provision to include new private and voluntary sector providers.

8. Allow GPs to hold patients’ budgets and commission care on their behalf.

9. Devolve decision making to cut the cost of NHS administration by a third and transfer resources to the frontline.

10. Create an independent board to allocate resources to different parts of the country and make patient access more equal and based on need.

More accessibility and accountability

1. Deny hospitals full payment for a treatment which leaves a patient with an avoidable infection.

2. End mixed-sex accommodation and increase the number of single rooms in hospitals.

3. Reform how drug companies are paid so that any cost-effective treatment can be made available through the NHS, with drug providers paid according to the value of the new treatments.

4. Provide access to a doctor or nurse when the GP isn’t open. Stop the closure of A&E wards.

5. Give mothers choice over where to have their baby and allow new providers to deliver maternity care. Introduce local maternity networks to improve access to services.

6. Introduce a new dentistry contract that ties newly-qualified dentists into the NHS for five years.

7. Remove the rules preventing welfare-to-work providers and employers purchasing services from mental health services.

Improve public health

1. The Department of Health will be renamed the Department of Public Health to give prevention more priority. 

2. Provide separate public health funding to local authorities. Extra resources will go to the poorest areas with the worst health outcomes through a new ‘health premium’.

3. The Conservatives will provide £10m a year funding beyond 2011 to support hospices in their work with children, and introduce a new per-patient funding system for hospices and providers of palliative care.

4. Give patients with chronic or long term conditions access to a single budget that combines their health and social care funding.

5. To protect people having to sell their homes to pay for residential care in older age, everyone on retirement will have to pay a one-off insurance premium of £8,000.

Reactions to the manifesto

Anna Dixon, acting chief executive of the King’s Fund, said: “Although there is much in the draft manifesto that chimes with current government policy - more foundation trusts and more choice for patients, for example - the document signals a number of areas where Conservative and Labour policy diverge.

“An independent board, changes to the way that drugs are approved and paid for, and real budgets in the hands of GPs could significantly change the way in which the NHS operates. But more detail is needed before the impact of such policies can be properly understood.

“There are also some issues which remain unanswered such as whether a Conservative government would seek to maintain the current waiting times achieved by the NHS.

“Whichever party forms a government after the next election, they will inherit an NHS facing the toughest financial challenge in its history. Whether or not current spending is protected, demand will continue to rise and the NHS needs to figure out how to do more for less without compromising safety or quality.”

Norman Lamb, shadow health secretary for the Liberal Democrats, said: “The NHS is facing enormous shortfalls in funding over the next few years yet the Tories continue to promise extra health spending without any details of where the money will come from.

“The time has come for David Cameron to be honest with the British public. If the Tories want to pledge extra spending on health in some areas then they must admit that without extra funds it will lead to cuts in frontline services elsewhere. And if they plan to remove all central targets how do they intend to prevent a return to the waiting lists of old?

“The sad truth is that David Cameron knows his health policies don’t add up. How else do you explain the sudden U-turn today on their flagship single room’s policy?”

Dr Peter Carter, chief executive of the Royal College of Nursing, said: “Having the right number and balance of skilled staff is the key to delivering quality care and in improving people’s health. Specialist nurses also play a vital role in improving care for people with long-term conditions and we are calling on all parties to support patients having guaranteed access to these specialists.

“We are encouraged to see signs that show the Conservatives intend to take a firm stance on public health and health inequalities but we are disappointed to have not heard more about issues such as tackling alcohol abuse. Specifically, we would have liked to have heard a firm commitment for a single mandatory code to better regulate the drinks industry.”

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Tories to give “the NHS back to the people”

By Mike Broad - 5th January 2010 10:25 am

Conservative leader David Cameron has said the NHS will be his “number one priority”, as the main parties step up their pre-election campaigning.

Unveiling the first part of a draft manifesto, he focused on three health issues - NHS reform, health inequalities and maternity services - and accused the government of top-down management.

On reform, he committed to giving the NHS “back to the people”. Cameron said: “It’s the patients who’ll have the power in our NHS. You’ll be able to check your health records online in the same way you do your bank account.

“You’ll have a real choice about where you get treated. You’ll have information about how good different doctors are, how good different hospitals are, information about things that really matter, like survival rates, the rate of hospital infections, your chances of going home to live independently if you have a stroke.”

He attacked the government over ongoing health inequalities saying they’re as bad today as they were in “Victorian times”. Cameron outlined the introduction of a health premium, which would “target resources on the poorest areas so we can banish health inequalities to history. With our plans, the poorer the area, the worse the health outcomes tend to be, so the more money they can get.”

He said how this additional money would be spent would be determined locally by local councils and directors of public health.

Cameron also unveiled a new approach to maternity services. He accused the government of creating “bigger and bigger baby factories” that were remote to patients.

The Conservatives will introduce maternity networks in which “local hospitals, GPs, charities, community groups and maternity consultants will all be linked up so that they can share information, expertise and services.”

He said: “Parents in many parts of Europe have a system that is more personal and more local - with more choice. And they also have lower rates of infant mortality. Why can’t our parents have the same?”

The Conservatives claimed to be the only party committed to protecting NHS spending.

Labour, meanwhile, released a document which they said showed a £34bn gap in Tory spending plans - a claim which Cameron later described as “junk”.

Responding to the manifesto, Anna Dixon, acting chief executive of the King’s Fund, said: “Whichever party forms a government after the next election, they will inherit an NHS facing the toughest financial challenge in its history. Whether or not current spending is protected, demand will continue to rise and the NHS needs to figure out how to do more for less without compromising safety or quality.”

Read an at-a-glance guide to the manifesto.

Read the full speech.

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Minister admits few patients will exercise choice

Healthcare Republic - 21st December 2009 5:57 pm

The majority of patients will ignore the government’s choice agenda and stay with the practice they are currently registered with, according to health minister Mike O’Brien.

Speaking during a parliamentary debate on Wednesday about scrapping practice boundaries, O’Brien said: “Of course, given a choice most people will stay exactly where they are; I believe that is what most people will do.

“Only a limited number of people want to exercise choice in this regard and, yes, sometimes they are well, middle-class people who just want the choice. Why on earth should they not have it? If they want it, the NHS should be able to provide them with it.”

The health minister was responding to MP David Taylor (Labour, North-West Leicestershire) who described Labour’s proposal to scrap practice boundaries as causing “a great deal of concern among GPs”.

Read more at Healthcare Republic.

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Patients ignore hospitals’ quality measures

By Mike Broad - 4th November 2009 8:39 am

Patients aren’t using quality measures when choosing a hospital to be treated at, research reveals.

The survey of over 2,000 patients, by the Kings Fund, shows that past experience, advice from friends and family or their GP influence their decision most. Only 4% had looked at NHS Choices - the government’s website for patients that provides data on hospital performance.

Since April 2008, patients referred by their GP for a specialist outpatient consultation have had a choice of any NHS or registered independent sector provider in England. This has been supported by the introduction of an electronic booking system, Choose and Book, but only half of eligible appointments were booked using the system in September 2009.

Half of respondents being referred said they were offered a choice of hospital; of those, 49% said they were given two options, 49% between three and five options, and 2% more than five options.

Patients offered a choice were only slightly more likely to travel to a non-local hospital (29%) than those who were not offered a choice (21%).

Almost half of respondents had been aware that they would have a choice before attending their GP, and those aware of choice were more likely to say they had been offered a choice of provider.

Patients were most likely to have been offered a choice by their GP (60%), in a letter outlining the options (21%), or by a telephone-booking adviser (20%).

Dr Anna Dixon, report co-author and director of policy at The King’s Fund, said: “There is still some way to go before choice is fully embedded in the NHS. Patients are not actively comparing hospitals or using performance data to select the highest quality provider, instead they continue to rely on their own experience or the advice of their GP.

“There is a wealth of information available for patients and GPs in official reports and on government websites. If policy makers want patient choice to drive up quality more needs to be done to let patients know this information is available and make the data relevant, accessible and easy to use.”

Read the full report.

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Cameron offers to scrap targets for more choice

By Mike Broad - 8th October 2009 3:53 pm

David Cameron offered to give doctors back their professional responsibility in exchange for more patient accountability at the Conservative Party Conference today.

In his leader’s address, he suggested the Conservative Party would lower the role of central government and empower NHS staff. He blamed “big” government for ongoing problems in the NHS.

He said: “With their endless targets and reorganisations, Labour have tried to run the NHS like a machine. But it’s not a machine full of cogs. It is a living, breathing institution made up of people - doctors, nurses, patients.

“This lever-pulling from above - it has got to stop. With Andrew Lansley’s reform plans, we’re going to give the NHS back to people.”

Cameron offered doctors a deal over greater patient choice. He said: “We’ll say to the doctors: those targets you hate, they’re gone. But in return, we’ll do more for patients. Choice about where you get treated. Information about how good different doctors are, how good different hospitals are.”

He also said he would improve patient information on the “things that really matter”, such as cancer survival times, the rate of hospital infections, your chances of surviving if you have a stroke.

He did pay tribute to the NHS and its staff. “My family owes so much to the National Health Service,” he said, referring to the treatment of his disabled son, who died earlier this year. “No, it is not perfect. But I tell you, when you’re carrying a child in your arms to Accident and Emergency in the middle of the night and don’t have to reach for your wallet it’s a lot better than the alternative.

“So we will never change the idea at the heart of our NHS that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay.”

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Health pressures mount globally for the big economies

By Mike Broad - 5th October 2009 3:50 pm

A report by the Economist Intelligence Unit examines the challenges facing different healthcare systems around the world.

For all the different permutations in healthcare systems around the world, the report - called Health reform: the debate goes public - suggests policymakers face several broadly similar challenges.

These are namely spiralling costs and increased demand. These factors are creating pressure just as the worst economic downturn in decades is stretching budgets. The need for healthcare reform is evident and in some countries, including the US and the UK, increasingly urgent.

As President Obama has suggested, unless major changes are implemented soon costs could severely cripple the world’s biggest economy. In the UK, the NHS Confederation recently warned that the NHS could face real-term funding reductions of up to £10bn from 2012.

For political leaders grappling with tight budgets in a financial downturn, health is simply too big an issue to ignore, the report says. Healthcare is forecast to account for a whopping 16.3% of GDP in the US in 2009, about 10.6% of GDP in Germany and 9.9% of GDP in the UK. Even in India, a country long criticised for under-investing in health and social services, the World Health Organisation forecasts that healthcare will account for about 5% of GDP in 2009.

Healthcare systems are complex, enormous and unwieldy, whether they are state-managed monoliths, such as the UK’s, or dominated by the private insurance sector, as in the US. The report says they are traditionally slow to adapt to change, but now those immovable objects are being forced to confront not just one, but several irresistible forces: demographic (ageing populations), epidemiological (increasing incidence of chronic diseases), technological (more expensive drugs and technologies) and economic (global recession, high public debt, smaller pensions).

These forces cannot be ignored. But try telling the end-users of healthcare about these pressures, and they will be nonplussed.

This report is based on a survey of four large economies - the US, UK, Germany and India - and what their public thing about their healthcare systems.

The findings show clearly the kinds of dilemmas faced by healthcare policymakers who seek to implement reforms.

The starkest example emerges when respondents were asked in basic terms about their expectations for choice and cost in healthcare. Globally, 83% of respondents say that they would prefer to shop between a range of options in order to get the best treatment. At the same time, however, more than half say that they are not prepared to pay more to get a better healthcare service, whether in the form of taxes, fees at point of provision or fees to insurers.

Consumers want choice - but are not prepared to pay for it.

The survey shows that citizens’ expectations for healthcare are high - not just in developed countries, which have been used to high standards of care, but also in developing countries such as India, where people are becoming accustomed to better standards.

Globally, the public want access to the latest treatments, timely, affordable care, and a range of choices. They are better informed than ever about their health and their treatment options. They are prepared to take some responsibility for their own health, but broadly they do not want to have to pay a lot more than they already are for their healthcare. If they are unhappy with aspects of their healthcare, they largely lay responsibility at the feet of their governments.

Key findings

The survey finds that:

1. Governments get a thumbs-down on their handling of healthcare. Not surprisingly, the economy and jobs are seen by respondents as the most important issues for their government, but healthcare takes second billing in the US, Germany and India - ahead of education, the environment, crime, defence and housing.

In the UK it comes third, after crime, but 29% of Britons are generally more inclined to think that their government has the right approach to healthcare. By contrast, just 8% of Germans think their country is on the right track, whereas 62% think their government has the wrong approach, as do nearly half of American respondents.

2. If patients are now customers, they are not happy ones. When it comes to healthcare, Americans, arguably, have more choices than citizens of most other countries. However, when asked to indicate their levels of satisfaction with a range of aspects of healthcare (such as waiting times, quality and availability of care and doctors, cost of treatment and medicine), almost one-quarter of Americans say they are not satisfied with any.

That was an even higher figure than in the UK (15%), where patients have far less choice. That does not mean Americans believe they receive poor quality care; compared with other countries, more US respondents are satisfied with the quality of their doctors, with waiting times and with general quality and availability of healthcare.

Strikingly, about one in five respondents across the global sample say they are not satisfied with any aspect of their country’s healthcare system.

3. Some patients are more empowered than others. Only one-quarter of UK respondents feel they have much control and influence over where and how they are treated, compared with 64% of Americans.

Nearly 60% of British respondents say that they are not encouraged to choose from a range of doctors or hospitals for their treatment. The UK government’s recent about-face, allowing patients to choose between public and private healthcare, without losing access to the NHS, appears to be a welcome one - three out of four respondents say that they would compare services to get the best possible treatment.

Meanwhile, US residents are more optimistic (74%) than those in the UK (61%) or Germany (38%) that they will get prompt, effective treatment if they become ill. Some 74% of Americans, however, say they are concerned about being able to afford that treatment - far more than Germans (55%) or Britons (50%).

4. Britons are not keen on fees, but are more relaxed about tax. UK citizens are less keen than people elsewhere on the idea of paying fees at the point of provision (co-payments), or to insurers, for an improved healthcare service. However, the survey found that more Britons (27%) would be willing to pay higher taxes for improved healthcare services than would Americans (15%) or Germans (9%).

Meanwhile, nearly 45% of Britons say that they would not be willing to pay anything extra, compared with 61% of Americans and 64% of Germans. The British are also wary of the notion that greater private-sector involvement would improve the country’s healthcare system, perhaps not surprising given that private healthcare takes up a relatively small amount of the country’s healthcare expenditure.

5. German gloom spells a warning to reformers. Germany began reforming its healthcare system a decade ago. Since then, according to Economist Intelligence Unit data, Germans are living longer and pay less for their healthcare than many of their neighbours. However, German citizens’ doubts about their healthcare system permeate the survey, just as German healthcare professionals revealed their pessimism in a separate survey earlier this year.

Far fewer German citizens (38%) than those elsewhere are optimistic that they will get prompt, effective treatment, more than half are worried about the costs of getting treatment, and far more (79%, compared with 57% in the UK and 36% in the US) feel their healthcare professionals are working too many hours to be effective.

The way forward

Against all this, the report claims policymakers are floundering to come up with solutions. They need to find a way to strike a grand bargain with patients, who are no longer simply passive recipients of care, but increasingly active consumers of health services.

The key issue is not necessarily one of knowing which reforms to implement. No matter how sensible reform plans may sound, there is generally one important stakeholder who remains unconvinced: citizens.

There is a big gap between policymakers and consumers when it comes to appetite for health reform. The first group sees it as an essential way to relieve financial and social pressures, while the second is afraid that they might lose what they currently have.

Consequently, selling healthcare reform is not a task for the faint-hearted. Even Mr Obama, who campaigned successfully on the issue in his presidential campaign, has struggled in his bid to implement a fairer system in the US.

The example of Germany, which implemented major reforms a decade ago, but whose citizens remain broadly pessimistic about their healthcare and distrustful of those who manage it, serves as a warning to would-be reformers.

If they are to be successful, policymakers must be prepared to be thick-skinned and patient, and to avoid quick fixes, the report concludes.

The results of broad-based reforms are unlikely to be seen overnight: South Korea’s plan to introduce universal healthcare coverage began in 1977, and is still being developed today. The UK, it says, has pumped millions of extra pounds into its NHS in the last decade, but it may be that the country’s more subtle reform strategies, such as patient-reported outcome measures, will be the ones that have most impact on cost containment and patient satisfaction in the long term.

Read the full report.

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Patient concern over waiting times and choice

By Mike Broad - 1:12 pm

Waiting times for surgery and a perceived lack of choice are still key concerns for the public in the UK, research reveals.

An international survey by the Economist Intelligence Unit shows that only 18% of UK respondents expressed satisfaction on waiting times for surgery versus 30% in the US.

The report, called Health reform: the debate goes public, also reveals that a larger proportion of UK respondents felt they have little or no influence over where and how they are treated, compared with respondents from Germany, America and India.  

Despite the UK’s Patient Choice initiative, six in ten respondents say they are not encouraged to choose from a range of doctors or hospitals for their treatment, even though three quarters would like the option to do so. In the US, by contrast, seven in ten respondents feel that choice is encouraged.

Few agree with the government’s use of the private sector to improve NHS healthcare delivery - less than a quarter think it will help.

One quarter of UK respondents said they would be willing to pay to reduce waiting times, a far higher proportion than in other countries. Although they are less keen than people elsewhere on the idea of paying fees at the point of provision or to insurers. A higher proportion of UK respondents would be willing to pay higher taxes for improved healthcare than would German or American respondents.   

British people are also more satisfied with the quality of their physicians, the report says.

Commenting on the report, a spokesman for the BMA said: “As well as confirming the high level of confidence people in the UK have in their doctors, this is further evidence of their lack of appetite for private provision of healthcare. It’s clear that they place a huge value on their publicly funded, publicly provided NHS - to the point where many would be willing to pay higher taxes to protect it.

“Politicians need to listen to their constituents and reject the tired dogma that the only way to achieve quality in the NHS is by exposing it to more competition.”

The BMA is currently running the Look After Our NHS campaign, which is seeking to significantly reduce commercial involvement in the NHS.

Iain Scott, the report’s author, said: “For many governments the financial outlook has worsened considerably, while the window for reform is getting narrower. This report finds that for healthcare reforms to be effective and receive the public support they need, policymakers must strike a bargain and do it soon.”

The study was based on a survey of 1,575 citizens from the UK, US, Germany and India, including 360 respondents from the UK.

Read the full report.

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