Envisioning 2.0

Yesterday, the New York Times published a story focusing on how the British National Health Service (NHS) quietly has evolved into a two-tier system.  That is, all patients receive free care, but must endure long waiting times and sometimes do not have access to the latest treatments.  Frustrated, some are bypassing the system and paying for parts of their care themselves.  However, the NHS is not allowing this practice to spread unfettered.  According to the Times: “Officials said that allowing [people] to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones.”

But, that’s happening already. The Times reports that “patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free.”

The United Kingdom’s hidden two-tier system was thrust into the spotlight when a female cancer patient, Debbie Hirst went to the press because officials would not allow her to pay for an expensive cancer treatment herself.

To me this story illustrates several points that are sometimes overlooked by some participants in the health reform debate:

1.    Countries that offer universal health care do a lot of rationing.  While it takes all comers, people often have to wait months or years for certain treatments.  Expensive medications are sometimes provided past the point where they may be effective.  (This happened in Hirst’s case.)

2.    The well-off will find ways to get better care.  Either they supplement their public insurance with private plans that offer additional services or they “go outside the system” to access treatments.

This is not to say that making access universal is not an admirable and necessary goal.  However, even in the most ideal situations, patients will practice consumerism and demand – and access – care that is not available to all.

This entry was posted on February 22, 2008 at 1:01 pm and is filed under Consumer-Driven Healthcare, Health Policy. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.