Dutch and Swiss top Euro health index, with UK 15th
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j522 (Published 30 January 2017) Cite this as: BMJ 2017;356:j522
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Editor
International comparisons and attempted rankings or league tables of health systems are always welcome and interesting. And a great deal of work goes into their preparation.
With regard to this one, i should point out to casual readers that it is but one of many such documents. We also have the Commonwealth Fund Report (which routinely places the NHS at the top on a scorecard of indicators including equity, universality and efficiency), the OECD, Economist Intelligence Unit analysis of OECD data, the Bloomberg report and others.
Some make no attempt to give systems overall ranking scores but stick to describing what is.
If you look at the OECD figures, you will see that systems near the top of the EHCI ranking generally spend more per capita on healthcare than those in the middle or towards the bottom. Indeed, the Netherlands and Switzerland are right at the top of European Spending League. Express the figure as a % of GDP spend and once again, those systems praised by EHCI are near the top of the spending league.
So another interpretation is that single insurer dominant provider systems like the NHS are better at keeping costs down than Bismarckian systems.
Secondly, although EHCI does indeed use a range of indicators, it is skewed towards consumerism, choice and customer focus and as such comes with an ideological underpinning skewed towards multiple provider/multiple insurer models. As such it delivers a ranking one might expect to see. If more weight were placed on overall cost, on equity of access between different socioeconomic groups, on universality (as for instance in the Commonwealth fund report) a different "ranking" would ensue
In any event there is currently no electoral mandate in the UK for multiple insurer model, for co-payments or partial fee for service. Indeed few politicians are prepared to have the public conversation.
What we must not do is fall into the trap of repeating often enough that only insurance models will deliver the change or funding levels we want to see. NHS funding as a percentage of GDP will be less than 7% by the end of this parliament, compounded by savage social care funding cuts.
We could make a political macro-economic choice to fund the service properly from national insurance and universal taxation. Let's see how well we would do if we spent anything like the per capita level that the Dutch or Swiss or Germans put into their health systems rather than automatically assuming that multiple insurers and providers is the only way
David Oliver
Competing interests: No competing interests
This report remains a fairy tale from Sweden.
Do read the diluted disclaimer (page 8 & 9) of the report which is mentioned in every report in the past and now: “the HCP takes care to state that the EHCI is limited to measuring the “consumer friendliness” of healthcare systems, i.e. does not claim to measure which European state has the best healthcare system across the board.”
And more over the EHCI repeats the same mistakes again when it comes to Dutch Data and is therefore most likely to be incorrect as I stated in my comment on the EHCI report 2015 in the BMJ:
Chapter: 1.3.1.1 "So what are the Dutch doing right?" The paragraph mentions: “160 primary care centres which have open surgeries 24 hours a day, 7 days a week”.
There are no such primary care centres in The Netherlands and I assume that the majority of Dutch GP’s are not looking forward to it either.
Same chapter of the EHCI report: “Here comes the speculation: one important net effect of the NL healthcare system structure would be that healthcare operative decisions are taken, to an unusually high degree, by medical professionals with patient co-participation. Financing agencies and healthcare amateurs such as politicians and bureaucrats seem farther removed from operative healthcare decisions in the NL than in almost any other European country.”
And I copy paste my writing from 2015: No interference of bureaucrats or insurers on the choice of treatment and therapy? The bureaucratic nightmare of the “permissions circus” apparently escaped the writers of the EHCI report.
This report remains a fairy tale from Sweden.
Competing interests: No competing interests