What other countries are copying from Britain's NHS
By A.McE.
IN BRITAIN arguments about the standards and efficiency of the National Health Service (NHS) can seem never-ending. The past year has been particularly bad: the system founded in 1948 by Aneurin Bevan, a Labour politician, has seemed to lack consistency and quality, and has been mired in scandals involving the neglect or mistreatment of hospital patients. The service is also struggling to meet a £20 billion ($33 billion) target of "efficiency savings" required to keep it within a budget which accounted for £105 billion in public spending in the year 2012/2013. Against this it might seem odd that many other countries—especially fast-growing ones in the developing world—are copying the NHS and importing some of its key ideas to help transform their health services. In particular, governments with large populations demanding rapid improvements on tight budgets are looking to Bevan’s brainchild for inspiration.
This is due, in large part, to an important founding principle of the NHS: a commitment to provide universal coverage across the population, regardless of income. This aspiration is now taken seriously in places such as South Africa, which has pledged to widen an inadequate public-insurance system for health care. A desire to close the gap between earnings and health-care entitlements has also driven reforms in the past decade in Mexico, with the NHS cited by reformers there as a model for more equitable health-care in poorer countries.
Another important selling point of the NHS as an export is that its per-capita costs are relatively low. The Commonwealth Fund, health think-tank based in Washington, DC, rated it among the top performers in the developed world for cost-efficiency. This is largely a result of its "single payer" structure, in which funding is raised though general taxation. Risk can be pooled more easily than in insurance-based schemes, and governments have greater control over total spending. There are also useful by-products such as a nationally accessible database for researchers. The NHS holds down costs in other ways, too. India is adapting England’s primary-care model, based on local practices staffed by doctors and nurses, to treat people close to home where possible and avoid building too many capital-intensive hospitals. And China, desperate to reduce inflation costs and a tendency for over-prescribing, is just one of several countries interested in emulating England’s National Institute of Clinicial Excellence, which measures the cost-efficiency of new treatments and medicines and recommends which of them should be available in the public-health system.
Just because it is regarded as a model abroad does not mean that the NHS can be complacent at home, however. Its emphasis on scale and equality of access has made it slow to adopt innovations that can benefit patients. Uniformity of treatment is often more theoretical than real: a belated attempt is now being made to open up more data on successes and failures in order to drive improvements in performance. And a continuing ideological spat about how much the NHS should co-operate with the private sector holds back potentially beneficial changes, as does the wide variation in the quality of its management. But its principle of service for all is an aspiration shared by many countries anxious to turn rising GDP into better health outcomes. That is not a bad legacy for the NHS, nearly six decades after its birth.
