LONDON (Reuters Health) Feb 06 - The founding ideal of Britain's National Health Service (NHS) - to provide comprehensive care from cradle to grave - may have "outlived its usefulness," according to a report commissioned by the British Medical Association.
It predicts that private health care will grow in importance as the NHS stops funding treatments that are judged to be of limited clinical effectiveness, not cost-effective or an inappropriate use of public funds.
However, it rejects alternative methods of funding the NHS, arguing that "on the grounds of both equity and efficiency, retaining a centrally tax-funded system which remains essentially free at the point of delivery is preferable to introducing other systems."
The report follows a BMA decision in 1999 to undertake a fundamental review of healthcare funding in the UK to see if changing the present system might stop the NHS from lurching from one financial crisis to the next. The BMA consulted widely and invited medical, nursing, pharmaceutical, private health and patient organisations to join a steering group, sift the evidence and publish findings.
Although Tony Blair's government has since injected substantial new money into the NHS, the report says that increased resources alone can never be a complete solution. In any case, it estimates that to endow the whole service to the levels of the most over-provided health services might cost as much as 2.4 billion pounds.
Rejecting new methods of financing, it says the social insurance (pay-roll) model popular in countries such as France and Germany would act a form of regressive taxation that would affect employment. It could also cost more to run than tax-based systems and be less successful in controlling costs.
As for a special health tax, the report notes, "The very characteristics which make hypothecation popular with the public make it unpopular with governments, and funding the health service from a specific tax source would be unlikely to provide any advantages over the current system."
It adds that introducing more patient charges would be unpopular and would be complicated by the fact that those most in need of healthcare are generally least able to pay for it.
The experience in other countries suggests that the problem of increasing demand and cost is widespread, whatever the means of funding, the report notes. It predicts a gradual shift from comprehensive NHS cover towards a package of core services. "Exclusions are likely to become more commonplace in future and will highlight the role of the private sector in providing treatments which are not available on the NHS."
However, it warns that even a bigger private sector cannot be a universal panacea, and it urges the government and the public to face up to the fact that some form of rationing is, and always has been, inevitable. Otherwise, the most vulnerable people will continue to suffer.