How to Pay for Health Care

The National Health Service, created just over 50 years ago, was regarded as the jewel in the crown of the post-war welfare state. It was launched on the assumption that, once the backlog of ill-health had been treated, demand for its services would drop. The reverse proved to be the case: demand grew year by year and, without the price mechanism to ration resources, the NHS was faced with recurrent funding crises. Aneurin Bevan, the Minister of Health who introduced it, resigned in protest when charges for dentistry and spectacles followed the planned introduction of prescription charges, in an attempt to balance the books. The NHS retains its popularity, but the complaints about 'under-funding' are as insistent as ever. Indeed, the revered status of the NHS is in itself part of the problem: any attempt at reform is perceived as an attack on a national institution. In this collection of essays the authors investigate different ways in which health care could be funded. Judith Allsop argues for the continuation of a centrally-planned service 'free at the point of use', on the grounds both of economic efficiency and social solidarity.
Michael Goldsmith looks at the possibility of introducing additional charges - for example, 'hotel charges' for hospitals - but concludes that the amounts raised would be insignificant as a proportion of the NHS budget. Chris Ham describes the Singaporean system which involves compulsory savings in Medisave accounts, an open acknowledgement of rationing, and the choice of different classes of hospitals. David Green argues that health care should be returned to the institutions of civil society: health authorities should become independent mutual organisations, and hospitals should become non-profit charitable trusts. Social solidarity could thus be achieved without having a state monopoly. The diverse viewpoints represented in this book make a timely contribution to the perennial debate about the funding of health services in the UK. "For Green, cultural acceptability would be restored by making health authorities independent mutual organisations and hospitals not-for-profit charitable trusts. Green argues that this would restore Health Service to civil society, out of the clutches of politicians." Journal of Social Policy.
"Health authorities should become mutual insurers in order to finance healthcare, according to How to Pay for Healthcare." Public Finance. "A fee of #5 to be seen by a doctor and a #10 a day charge to stay in a hospital would not raise enough money to be worth the bother, it is claimed today." The Scotsman. "David Green...suggests that health authorities should become independent mutual organisations acting as champions of patients; and wants hospitals to become non-profitable charitable trusts." The Observer.