Danny Dorling and one of his disciples have decided to tell us how good Finnish health care is compared to our own dear National Health Service – that wonder of the world that it is. And they’re right, there are things about that Nordic system which are better than our own and policies we should adopt.
The most obvious being that we should abolish that National Health Service:
According to the OECD, Finland spends a slightly lower proportion of its GDP (9.5%) on health than does the UK (9.7%). Finland can do far more with that money partly because doctors don’t need to be paid as much as they are in the UK, since housing costs are lower. For every 10,000 people in Finland, there are 32 doctors employed, compared to 28 in the UK, and there are 40 hospital beds for every 10,000 Finns, compared to 26 in the UK.
How excellent. But they are rather missing the two bits that really are different. The first is that there are copayments. You pay – real money, from your wallet – to see a doctor. And you get charged a hotel fee in hospital. Modest amounts, certainly, perhaps 15% of the costs of actually providing those things. But not free at the point of use, one of the things which reduces consumer demand.
And then there’s the absence of a national system. Taxes are raised locally to pay for care locally. This means that everything is subject to what I’ve called Bjorn’s Beer Effect. The thing being there are very few national, universal, health care systems:
There are indeed national health care systems out there–but they tend not to be single payer. And there are single payer systems out there, or close enough at least–but they tend not to be national. Which is something that we really ought to be thinking about, no?
Such a system will also be subject to what I’ve called Bjorn’s Beer Effect here before. If Bjorn is the bloke who sets your tax rate and Bjorn is the guy who decides where the money is spent, then in a community of 6,000 to 30,000 people you’re going to know, or at least be able to find out, where Bjorn has his Friday night snifter. Which is going to put the fear of God into Bjorn as he spends your money: but also means that there’s one human individual to explain to you, forcefully if need be, why you can’t have what you’re not willing to pay the taxes for.
That is, to make the NHS like the Finnish health care system we’ve got to abolish the national bit and start charging for it too. Which, amazingly, isn’t what Danny Dorling and his acolyte tell us. Wonder why….
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You run into the same thing here in the US. They bring up the Nordic countries as an example of how great their social programs work but instead of proposing the systems that those countries use to get those great results they propose systems that work pretty much the exact opposite.
"These countries get great results but instead of doing it the same way we recommend something completely different"
Boggles the mind more than a little.
The idea that some people are taking advantage of 'free at the point of use' so they can visit the doctor to hang around in a waiting room with sick people or even worse to stay in a hospital with no wifi, smelly people and their annoying visitors, that idea is ridiculous. You economists might have some thing about infinite demand for a free good, but there is nothing GOOD about those things.
Apart from that, if there is a real problem with time-wasting, just as with 999 calls and other attention-seeking behaviour, it will be confined to a few problem perpetrators and should be dealt with on that scale not on a whole population basis.
And what have doctors' salaries got to do with housing costs? Invalid connection. Housing costs vary internally in the UK (I can't say about Finland) far more than doctors' wages do.
I know of retired folk who will go to the doctors to get a (free) prescription for paracetamol in order to save spending 32p on it at Tesco. Now, that's a significant cost to the taxpayer: somewhere in the region of £25 for the GP consultation, about £2 for the dispensary fee to the pharmacy and a rounding error for the actual paracetamol. Separately, any GP surgery will tell you that they have significant numbers of 'no-shows' who instead of cancelling an appointment will just not turn up if they are unable to attend or no longer need the appointment. One practice I was at put up a chart in the waiting room, showing that typically 7-10% of appointments were missed. And go to any A&E on a Friday or Saturday night and you'll see plenty of people who should have just put a plaster on their booze-induced injury and gone to bed with a bucket.
Fair comment but there is also the other side that the NHS puts no value whatsoever on the patient's time so, while the NHS demands that they turn up on time (and can have the appointment cancelled if they are late) they are frequently left to wait for half-an-hour or an hour beyond the agreed time in the waiting room*. When I try to make an appointment to see a GP, I have to wait for two weeks or more, by which time I am likely either to have recovered or to need hospital treatment.
That is not what I should choose to call a Service.
*The most horrendous example I saw was twenty-odd years ago but it still rankles - my wife and I had to take our younger son to see a specialist and we were put in waiting room of expectant mothers (from the look of it in their third trimester) *all of whom* had been required to turn up at 9 am for a session which lasted until 1.30 pm lest a minute of the doctor's time be wasted while he waited for the next patient. That is the difference between "Social Justice" and genuinely caring.
I know worse than that. I used to know a Slovak Translator and she said she would translate for people who wanted to see a GP just to get a free paracetamol. So they had a double appointment and of course she got paid.
Of course, Danny Dorling will not mention that the Beveridge plan was for sub-regional health services which would have resulted in comparisons between different treatments accelerating medical progress as well as much reduced bureaucracy (bureaucrats being proportional to the square of the number of front-line workers per unit so the total bureaucracy grows if you merge several viable units into one super-unit). The argument about creating the NHS was not that the Tories opposed the creation of a NHS but that Bevan didn't want the Beveridge plan and rammed through an inferior alternative at vast cost - he filled the mouth of the RCS with gold to get their agreement.
I heard a radio programme once about , when the oil companies negotiated with the Shetland Islands they were amazed at how hard the councilors negotiated with them. One of the councilors said, we were negotiating for our friends and neighbours, "How could we look them in the face, if we got a bad deal?". Completely different from the UK national government.
This of course is a prime example of the agent principal problem.