Intended for healthcare professionals


The NHS through American eyes

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1545

Nationalised health care differs from free health care

Leatherman and Berwick espouses the ideals of the NHS, and indeed the
philosophy behind the NHS is admirable. However, the main problem with the
NHS is that it creates a market in which the demand exceeds the fixed
supply, but unlike other economic markets, there is no mechanism through
which the demand can be regulated. Because it provides services free at
the point of delivery, users of the NHS treat it as a "free good"
notwithstanding what we pay for it through our taxes, and this is
unsustainable in the long term.

Economically, the NHS is a scarce resource, and we should introduce a
"price" into it in a way such that the demands on it can be fairly
distributed. Charging a fixed price for A&E attendances regardless of
the severity of the medical condition for example, would be a simple way
of controlling its usage, because patients with trivial illnesses would be
less inclined to attend A&E departments if they had to pay for it --
the inherent price elasticity of health care demands.

Yes, we should depoliticise the NHS, but it is time our politicians
take a good hard look at the NHS to see how we can square the supply with
the demand to ensure that the NHS remains the "envy of the world" as one
health secretary liked to call it. Otherwise, we in the NHS will one day
become exhausted hamsters unable to run any further.

Competing interests: No competing interests

27 December 2000
Wen-Hann Tan
Senior House Officer
Addenbrooke's Hospital, Cambridge