I have looked at this White Paper and attempted to convert the words into a diagram, so one can see who does what, who is in charge, who talks to whom and why.
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1. In no way can one say the individual is in charge or has any real influence here. If you look closely, we sit in the lower left corner.
2. GPs are forced into being part of one and only one Consortia.
3. If a GP is good but the Consortia is operating in a way that is not agreeable, patients have a dilemma. This is unacceptable, especially as there is often not a surplus of GPs and so one may end up with a de facto Consortia monopoly.
4. Consortia are beholden to the Commissioning Board, not patients.
5. It is not clear how effective risk pooling will be in such Consortia, especially as the arrangement appears to presume that they will be very much a local grouping.
6. The Practice Budget setting appears to be dysfunctional and unnecessary. Either funding follows the patient or it does not. This appears to enable a degree of “mumble-swerve” into the process and this is therefore at risk of abuse.
7. `The “Local Authority” role is not clear. They appear to be able to function as a cipher or arbiter over the wishes of patients/individuals. Not a good thing if one has a Local Authority that does not respect your wishes.
8. The scope for local or National fiefdoms has not been dealt with.
The problem as anyone can see from the diagram is it is too rigid and dictatorial. There are no alternative ways of operating. It is a monoculture and the problem with monocultures is it is slower to realise or wish to realise what can be done better and when it decides, it often takes too long to implement it so that a further development can come along before the previous innovation has been implemented.
Some good points
1. Convert NHS Hospitals into independent trusts
2. phase out Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs).
3. Funding follows the patient…sort of.
This is quite a different system to that which we might see in the first few years of a Libertarian Party administration.
What follows is a potential alternative, but not formal policy position by any means. It is offered so as to reveal the complexity and bureaucracy of the White Paper proposition.
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Providers commission services from other providers. GPs commissioning Hospitals, Insurance Services commissioning GPs etc.
The Dept of Health is shown with a supervisory role, but more along the line of upholding Rule of Law, as in misrepresentation, fraud, coercion, theft, abuse etc.
The above includes the concept of Voucher/State funding to show how Healthcare would evolve within the first Parliament. The nature of that funding, therefore needs to be mentioned.
Trying to pretend that Taxpayers must fund a voucher with no oversight or controls whatsoever is also unrealistic, which is why the “Baseline Care” concept needs to exist alongside any voucher scheme.
Vouchers:
Ideally it establishes price, quality and delivery competition between providers, for this ensures that the providers have their face towards the patients, not the State, so reducing what is called the Third Party Payer problem, whereby providers meet the needs of what appears to be the immediate funder, not the consumer. Trying to fund everything via a voucher funded by direct taxation also invalidates a significant portion of the power in a voucher for the patient, for it is reduced to an amount argued between provider and State.
This, then, implies that the voucher for most people does not cover "everything"*.
I put it to you that it would be better to top up the care costs of the few - poorest, ideally via Friendly Societies - instead of trying to provide all the care costs of everybody via a voucher.
I put it to you that if items are not covered, they are at the lower end, the elective, the cosmetic and small but many, as in the “deductibles” of healthcare plans one can find, e.g. a routine check up will not be covered, but cancer is. This ensures the catastrophic is dealt with without a blink, but one decides if that visit to the GP for flu is really necessary, or one bears the cost of IVF or cosmetic surgery. This is what would be defined in "Baseline Care".
The above mechanism combines the provision of core care with price, quality and efficiency competition. The real kind, not the faux “contestability” touted in the White Paper.
I am sure there are many other ways to deal with how to fund, or manage the funding of, the healthcare provision of the poor, but a single universal cover-all non means-tested voucher is probably one of the worst.
What is primary here, though, is that the Individual chooses their providers, be they GPs, Polyclinics, Hospitals etc. and as such the providers are constantly subjected to the scrutiny and immediate judgement of the population on delivery and cost.
* As we know, in truth, an attempt to cover "everything" is a conceit. In reality it does not happen.
Edited 18:04 19 Jul 2010.
2 comments:
I like it; subsuming the cost of catastrophic health problems whilst pushing elective treatments and basics like GP visits back into the individuals hands.
One small problem I see is sadly unavoidable and who'd be the same with education; when you allocate an amount like this to basic health you are artificially creating a minimum price for that service.
Don't see how that can be avoided and provide minimal care, unless it becomes discretionary spending (hard to administer/enlarged beuracracy etc).
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