The view from abroad
http://www.100md.com
《英国医生杂志》
NSH Centre for Healthcare Improvement, New South Wales
The Australian analyst Ross Wilson thinks that Labour's plan to reward high performing hospitals could be as important as the Tories' plan to channel money into the private sector
When British voters go to the polls in May they will be able to choose between the parties on the basis of health policy posted on their websites. My discussion is based on the documents available on those sites and does not make any assessment of the likelihood of implementation of these policies.
All the three main parties presume that the current clinical performance in the NHS can be improved, although Labour asserts that current performance has already improved substantially during its tenure. Its claims are supported by data indicating better clinical outcomes for cancer and heart attack patients, as well as data indicating a significant increase in capacity through funding and increases in the workforce.
All the parties seem to ignore the longer term question of whether the NHS model of free universal access is in fact financially sustainable. This seems a particularly relevant question given that the cost of delivering health care in developed countries is rising much faster than gross domestic product in those countries.
All the parties aspire to more involvement of the private sector in delivering health services in a way that should increase capacity; but marked differences in their approaches will have implications for cost, choice, and equity. Undoubtedly Conservative health policy would lead to a major flow of public money to private providers—whether the money comes from government or individual patients—with the party's promise to contribute 50% of the NHS cost of an operation to an independent provider of that service.
Although all the parties make a commitment to patients' choice, their definition of the term varies. It could mean choice of GP, of specialist or procedural doctor, of hospital, and of public or independent provider. None of the parties properly addresses whether patients have enough information to make informed choices.
Another aspect of choice that is explicitly included in Labour policy is that higher performing facilities will have a higher income as a result of more patients choosing their care. This represents a fundamental shift from current funding methods that could be as significant as the Tory use of public funds for the independent sector.
The Tories and Liberal Democrats promise to reduce red tape in managing the health system and to undo some recent structural changes, such as strategic health authorities in the case of the Tories. Of much more strategic importance are the promised abolition of centrally driven targets by the two larger parties and the proposal for local commissioning of care by the Liberal Democrats. Both these proposals could lead to considerable geographical variation in clinical care and outcomes and hence could threaten equity of care (and its transparency) across the country. The unpopular aspects of targets deserve a more sophisticated discussion: are they a bad idea or a good idea whose implementation could be improved?
It is encouraging that the Tories and the Liberal Democrats specifically address public health policy and mechanisms of delivery.(Ross McL Wilson, director)
The Australian analyst Ross Wilson thinks that Labour's plan to reward high performing hospitals could be as important as the Tories' plan to channel money into the private sector
When British voters go to the polls in May they will be able to choose between the parties on the basis of health policy posted on their websites. My discussion is based on the documents available on those sites and does not make any assessment of the likelihood of implementation of these policies.
All the three main parties presume that the current clinical performance in the NHS can be improved, although Labour asserts that current performance has already improved substantially during its tenure. Its claims are supported by data indicating better clinical outcomes for cancer and heart attack patients, as well as data indicating a significant increase in capacity through funding and increases in the workforce.
All the parties seem to ignore the longer term question of whether the NHS model of free universal access is in fact financially sustainable. This seems a particularly relevant question given that the cost of delivering health care in developed countries is rising much faster than gross domestic product in those countries.
All the parties aspire to more involvement of the private sector in delivering health services in a way that should increase capacity; but marked differences in their approaches will have implications for cost, choice, and equity. Undoubtedly Conservative health policy would lead to a major flow of public money to private providers—whether the money comes from government or individual patients—with the party's promise to contribute 50% of the NHS cost of an operation to an independent provider of that service.
Although all the parties make a commitment to patients' choice, their definition of the term varies. It could mean choice of GP, of specialist or procedural doctor, of hospital, and of public or independent provider. None of the parties properly addresses whether patients have enough information to make informed choices.
Another aspect of choice that is explicitly included in Labour policy is that higher performing facilities will have a higher income as a result of more patients choosing their care. This represents a fundamental shift from current funding methods that could be as significant as the Tory use of public funds for the independent sector.
The Tories and Liberal Democrats promise to reduce red tape in managing the health system and to undo some recent structural changes, such as strategic health authorities in the case of the Tories. Of much more strategic importance are the promised abolition of centrally driven targets by the two larger parties and the proposal for local commissioning of care by the Liberal Democrats. Both these proposals could lead to considerable geographical variation in clinical care and outcomes and hence could threaten equity of care (and its transparency) across the country. The unpopular aspects of targets deserve a more sophisticated discussion: are they a bad idea or a good idea whose implementation could be improved?
It is encouraging that the Tories and the Liberal Democrats specifically address public health policy and mechanisms of delivery.(Ross McL Wilson, director)