Education And Debate

Stakeholder health insurance: empowering the poorest patientsCommentary: Stakeholder health insurance has disingenuous aims

BMJ 2001; 322 doi: (Published 31 March 2001) Cite this as: BMJ 2001;322:786

Stakeholder health insurance: empowering the poorest patients

  1. David G Green, director (
  1. Institute for the Study of Civil Society, Elizabeth House, London SE1 7NQ
  2. King's Fund, London W1G 0AN

    The NHS aims to be universal, comprehensive, equitable, and of a high standard but fails to achieve its objectives. Are there any overseas systems that guarantee all their people—especially the poorest members of society—a higher standard of care than the NHS? An honest observer looking at countries such as Germany, France, or the Netherlands would have to answer this question with a resounding “yes.” Can we learn from them?

    Summary points

    The NHS does not meet its own objectives to be comprehensive, equitable, and of a high standard

    It has three long standing problems: underfunding, lack of competition, and lack of respect for individual choice

    Stakeholder health insurance would use the market to improve care for everyone

    Patients who opt out of the NHS would receive a tax rebate in proportion to their earnings

    Advantages of social insurance

    One advantage of European social insurance is that the standard and range of cover is linked to judgments about affordability made by people who are self sufficient through work. In Germany and France, people can see on their pay slips how much they are paying for health care and form a view about whether the cost is justified. The state guarantee reflects personal preferences to a greater extent than a system financed from taxes. Put another way, the French and Germans have found a way of making the market serve everyone.

    The government's national plan for the NHS dismissed overseas alternatives because they failed the test of equity. But in which European countries would you find the widest gap between the standard of care enjoyed by the poorest people and the standard enjoyed by the rich? The people with most to lose are those who depend exclusively on the government for services. The wealthy can always take care of themselves. In countries such as Germany, France, and the …

    Correspondence to J Dixon

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