Getting more for their dollar: a comparison of the NHS with California's Kaiser PermanenteCommentary: Funding is not the only factorCommentary: Same price, better careCommentary: Competition made them do it
As has been commented upon, the business of making comparisons
between health systems is difficult. In addition to the several issues
already cited by respondents the article by Feacham et al gives an NHS
cost of £58.5 bn but revenue allocations this year to Health Authorities
in England are in fact £37,157m.
If the £58.5 bn cited includes all NHS expenditure (and not just
allocations to health authorities) in England then there are some very
real comparative problems. Not included in the £37 bn figure above, but
possibly in the £58.5 bn figure, would be central budgets of the
Department of Health that fund - amongst other things - undergraduate
nursing tuition and bursaries as well as those for allied health
professionals and additional costs associated with teaching hospitals.
These alone total to nearly £1.5 bn. Presumably the Kaiser figures do not
include the costs of training and educating the health workforce in
California. The £37, 157m figure for health authority allocations includes
amongst other things includes expenditure on public health and ambulance
services. Presumably Kaiser Permanente does not fund the Public Health
departments at state, county or municipal level in California or ambulance
services in the state?
The article also refers to the UK and uses the population of the UK.
The Department of Health is the health department for England only and not
for Scotland, Wales or Northern Ireland. Nor is it the UK's department of
health as responsibility is split between the four constituent countries
of the UK. The Secretary of State for Health is accountable to the UK
Parliament but only for the money voted for use in England. It is not
clear therefore whether the £58.5 bn relates to England alone or is an
aggregate of the funding in the four countries.
Given the central conclusions in the article about the comparability
between the NHS in the UK and Kaiser Permanente it would be important for
the NHS funding and population figures to clearly relate to one of the
countries alone or the UK as a whole and for the NHS expenditure figure to
be analogous to the services covered by Kaiser Permanente.
Rapid Response:
Comparing like with like?
As has been commented upon, the business of making comparisons
between health systems is difficult. In addition to the several issues
already cited by respondents the article by Feacham et al gives an NHS
cost of £58.5 bn but revenue allocations this year to Health Authorities
in England are in fact £37,157m.
If the £58.5 bn cited includes all NHS expenditure (and not just
allocations to health authorities) in England then there are some very
real comparative problems. Not included in the £37 bn figure above, but
possibly in the £58.5 bn figure, would be central budgets of the
Department of Health that fund - amongst other things - undergraduate
nursing tuition and bursaries as well as those for allied health
professionals and additional costs associated with teaching hospitals.
These alone total to nearly £1.5 bn. Presumably the Kaiser figures do not
include the costs of training and educating the health workforce in
California. The £37, 157m figure for health authority allocations includes
amongst other things includes expenditure on public health and ambulance
services. Presumably Kaiser Permanente does not fund the Public Health
departments at state, county or municipal level in California or ambulance
services in the state?
The article also refers to the UK and uses the population of the UK.
The Department of Health is the health department for England only and not
for Scotland, Wales or Northern Ireland. Nor is it the UK's department of
health as responsibility is split between the four constituent countries
of the UK. The Secretary of State for Health is accountable to the UK
Parliament but only for the money voted for use in England. It is not
clear therefore whether the £58.5 bn relates to England alone or is an
aggregate of the funding in the four countries.
Given the central conclusions in the article about the comparability
between the NHS in the UK and Kaiser Permanente it would be important for
the NHS funding and population figures to clearly relate to one of the
countries alone or the UK as a whole and for the NHS expenditure figure to
be analogous to the services covered by Kaiser Permanente.
Competing interests: No competing interests