Fascinating. A couple of thoughts on "choice". A starting point would be to try to identify clearly what discrete clinical "choose-able services" could be offered, essentially as service-products. In themselves, these come in separate response domains; diagnostics, assessments, treatments and follow up. Could we then find market incentives and/or prices to release these into the NHS as a load-reduction offer. (This has been done to some extent in orthopaedic surgery outsourcing.)
If pathways could be developed to deliver choice, (the unions will not like it) an issue arises; the management of multiple needs - for example a broken hip procedure resolved through a choice offer, reveals an expensive long term osteo-arthritic treatment need. While GPs can probably act as guides and gatekeepers; some sort of incentive has to be found to constrain total spending or we are back to constraint by insurance refusal or NHS rationing. (Both arise because you cannot easily and objectively assess a cost-benefit measure for any one patient at any one time of life against another patient - unless they are paying).
That aside, I do think identifying choices (and individual preferences) is a useful key starting point to developing any new health policy away from the sclerotic monolith of today.
. Very good and very valuable contribution because it attempts to provide a road map to get from (a depressing) here and now to the prospect of a better outcome. How can these thoughts be taken forward. Can they be read by the Health Minister?
I think the article is helpful but it doesn't specify what the really benefit of choice is. The major benefit comes from the development of market place, albeit a heavily regulated one, where value for money (price) discovery can take place. And 'value for money' needs to be ascertained over the whole treatment cycle.
As every world class service company knows, getting it 'right' 1st time generates the lowest cost acceptable outcome. In Germany there is a hybrid market place with local government, regional and state providers competing with providers from the private and charitable sectors for contracts with insurance companies.
The insurance companies themselves are run by the public, the private and the third sectors. And they have to compete on value for money but with the state insurers acting as a safety net. The issue is how to overcome the vested interests who benefit from the NHS, a communist style hierarchical state monopoly, and transition UK health care to a market place where choice exists.
Fascinating. A couple of thoughts on "choice". A starting point would be to try to identify clearly what discrete clinical "choose-able services" could be offered, essentially as service-products. In themselves, these come in separate response domains; diagnostics, assessments, treatments and follow up. Could we then find market incentives and/or prices to release these into the NHS as a load-reduction offer. (This has been done to some extent in orthopaedic surgery outsourcing.)
If pathways could be developed to deliver choice, (the unions will not like it) an issue arises; the management of multiple needs - for example a broken hip procedure resolved through a choice offer, reveals an expensive long term osteo-arthritic treatment need. While GPs can probably act as guides and gatekeepers; some sort of incentive has to be found to constrain total spending or we are back to constraint by insurance refusal or NHS rationing. (Both arise because you cannot easily and objectively assess a cost-benefit measure for any one patient at any one time of life against another patient - unless they are paying).
That aside, I do think identifying choices (and individual preferences) is a useful key starting point to developing any new health policy away from the sclerotic monolith of today.
. Very good and very valuable contribution because it attempts to provide a road map to get from (a depressing) here and now to the prospect of a better outcome. How can these thoughts be taken forward. Can they be read by the Health Minister?
I think the article is helpful but it doesn't specify what the really benefit of choice is. The major benefit comes from the development of market place, albeit a heavily regulated one, where value for money (price) discovery can take place. And 'value for money' needs to be ascertained over the whole treatment cycle.
As every world class service company knows, getting it 'right' 1st time generates the lowest cost acceptable outcome. In Germany there is a hybrid market place with local government, regional and state providers competing with providers from the private and charitable sectors for contracts with insurance companies.
The insurance companies themselves are run by the public, the private and the third sectors. And they have to compete on value for money but with the state insurers acting as a safety net. The issue is how to overcome the vested interests who benefit from the NHS, a communist style hierarchical state monopoly, and transition UK health care to a market place where choice exists.