The NHS has a total payroll of over 1.5 million (only the Chinese People’s Liberation Army and Indian Railways directly employ more people) but less than 50% are clinically qualified. That makes the NHS a bureaucratic monstrosity. In the last major international survey by the WHO the NHS barely made the top 20 in what it is supposed to be good at (financial fairness and equal care for all). As regards providing the healthcare level and responsiveness it was simply dire. This is clearly the reason no one has ever bothered to copy the British healthcare system, even though we were told endlessly in the past that it was the wonder of the world. However the question going forward must be: how do we deliver better outcomes for less money? We could look at France which topped the 2000 World Health Organisation list of best national healthcare services. But perhaps we should be looking even further to the East. The Singaporean government spends just 1.3% of GDP on healthcare, while the combined public and private healthcare expenditure was just 4.3% of GDP. Yet infant mortality and healthy life expectancy rates are better in Singapore than in the UK. Singapore’s secret is to mix market pricing with incentives to minimise costs and waste. So the government pays for basic healthcare, but recovers between 20% and 100% of its outlay from patients. Private individuals must save up for potential medical expenses through mandatory pay deductions, which are supplemented by employer contributions, into ring-fenced personal healthcare accounts. Patients can choose what non-essentials to spend their money on, but the government ensures they can afford healthcare.


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