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Feature Health Economics

The credit crisis and health care

BMJ 2008; 337 doi: (Published 29 October 2008) Cite this as: BMJ 2008;337:a2259
  1. John Appleby, chief economist
  1. 1King’s Fund, London W1G 0AN
  1. j.appleby{at}

    With the current financial turmoil affecting the cash flow of governments, business, and individuals, John Appleby assesses the likely effect on the NHS

    It is hard to resist apocalyptic phrases (indeed, the use of the word apocalyptic) in describing the effect of the credit crunch on the world’s banking and financial systems over the past year. But it is not just the somewhat unreal and mystifying world of credit default swaps, naked short selling, and eyewatering bonuses that has been affected. As has become much clearer in the past few months the scale of the seizure in wholesale credit markets is such that the effects are being felt in the real world.

    As the government commits potentially hundreds of billions of pounds to supporting banks and guaranteeing depositors over the next few years, borrowing huge amounts in the process and pushing national debt to over half the UK’s gross domestic product, it is hard not to foresee some effect on public services. What, then, might be the immediate and longer term prospects for the National Health Service and, indeed, the nation’s health?

    As the speed and scale of the unfurling of the credit crunch has shown, predicting the future is not an easy task—even for those with a substantial personal financial risk at stake. Nevertheless, the short (and short term) answer to the question of the direct effect of the crisis on the NHS is that it will, with some qualified hedging, be minimal. However, the longer (and longer term) answer is more complicated.

    Short term: scarce credit and lost deposits?

    In the short term the credit crunch will affect public organisations with deposits in commercial banks and reduce the ability of private sector health providers to borrow to fund developments. Already there is evidence of cutbacks in the private sector. Virgin Healthcare, for example, announced in …

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