Are we destined for a Korean health care system as Labour suggests? - blog by Emma Spencelayh There can be no doubt that election season has well and truly started, with the NHS as one of its central issues. In the midst of growing concern about A&E waiting times, Labour published The NHS as you know it cannot survive five more years of David Cameron, alongside a poster campaign. Last week in Prime Ministers Questions, David Cameron accused the Labour Party of seeking to turn the NHS into a political football. These accusations are nothing new – the NHS has been a political beast for decades and it rings hollow for any of the main parties to pretend that this isn’t the case. In 2010, the NHS did not feature particularly heavily in the run up to the election; the only reference to the NHS in the initial coalition agreement between the Conservatives and the Liberal Democrats was to a commitment that NHS funding should increase in real terms in each year of the Parliament. This time round, Labour appears to have staked their election campaign on the NHS and, more specifically, attempting to discredit the Conservatives track record since 2010. A recent YouGov poll suggests that Labour’s poster campaign may be working, with 48% of those polled agreeing with the claim that the NHS couldn’t survive five more years of David Cameron, versus 32% who did not agree. The main messages had echoes of Labour’s 1997 manifesto which stated that if the Conservatives are elected again there may well not be an NHS in five years’ time – neither national nor comprehensive. Labour’s document is structured around three main claims: - The NHS cannot survive another five years of deteriorating service standards - The NHS cannot survive five years of Conservative plans to reduce the overall level of spending on public services to levels not seen since the 1930s - The NHS cannot survive five years of the Conservative plans to put privatisation before patient care. Like in 1997, what’s really underpinning this campaign is an assertion that the Labour party can be trusted with the NHS in a way that the Conservatives cannot. One line in the Labour document that piqued my interest in particular was a claim the Conservatives would cut public spending on services to levels seen in countries where up to half of their health service is privately funded. The document makes specific comparisons to Mexico and [South] Korea, implying cuts to overall public spending would result in a reduction of government spending (versus private spending) on health care, which could threaten the current system of comprehensive coverage funded by general taxation. Is this a fair assumption? The Labour Party have calculated that if the Conservatives cut overall public spending to a 35% share of GDP, public spending on health would fall to similar levels as those countries with a similar level of overall public spending within the OECD, such as Mexico and Korea. The document suggests that for those countries with public spending below 35% of GDP in 2012, the average for health spending funded by public sources was 55%, compared with 84% in the UK. South Korea has a compulsory social health insurance system which was established in 1977. A small proportion of the population is covered by a welfare programme for the poor. The Mexican health system is also based around an insurance model but has a national health insurance programme, introduced in 2003 in order to provide access to a package of health services for those excluded from insurance. While both these countries have public systems in place to support those less able to pay insurance premiums and have reached universal coverage, their health care systems are clearly structured on fundamentally different lines. Labour’s document fails to take into account the fact that public spending on health is high in the UK because of the system we have adopted: universal coverage and comprehensive benefits available in a national health system funded from general taxation rather than private contributions. Using the same approach but in reverse, it is possible to compare the UK with OECD countries who have higher rates of public spending as a proportion of GDP. While countries such as France and Sweden spend a higher proportion of GDP on public services when compared to the UK, the rates of public spending on health are higher in the UK. So the relationship between overall levels of public spending and the share spent on health across different countries is not straightforward. Labour is right to highlight the challenges of protecting the NHS budget in the face of broader public spending cuts. However, it is a bit of a stretch to suggest that we are facing Korean or Mexican levels of public spending on the health service unless there is a significant change to the way the NHS is currently financed. That does not seem to be on the cards for any of the three major parties, including the Conservatives. Indeed, the NHS Five Year Forward View was clear that while the financial situation is challenging, there is nothing to suggest that continuing with a comprehensive tax-funded NHS would be intrinsically undoable. While there appears to be consensus around the principle of maintaining an NHS that is free at the point of need and funded through taxation, there are policy differences which warrant proper debate. As we move closer to the election, different political parties and others will be promoting a range of different policy proposals. Our briefing on Clive Efford’s private members bill has already highlighted some differences – for example whether it matters who owns providers of NHS-funded services and the role of competition in the NHS. The Health Foundation (an independent charity) will be publishing a series of briefings and blogs in the run-up to the 2015 general election, to inform the ongoing public debate on health care policy. These materials will analyse and discuss key issues raised by political parties and others about health care policy and the NHS. Emma is a Senior Policy Advisor at the Health Foundation, twitter/ESpencelayh See the reaction to this blog at bit.ly/1AM6qEH
Posted on: Thu, 15 Jan 2015 11:10:56 +0000
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