12 August 2009

Would you let the NHS take care of your car?

Here's one view of what NHS style car repairs would be like - though it is not a picture Dr Grumble recognises:

Now lets look at how an insurance system might work for car repairs. You buy an old car and you insure it for unexpected repairs because you are worried it might break down. The car is essentially a banger so you pay a lot for the insurance - more than you can afford. If you are employed and need your car for work you may be lucky enough to have your employer buy the car and pay the insurance for you but he will deduct the insurance from your pay. You may not get much choice in what cover your employer purchases for you even though it is effectively your money.

Then, unfortunately, one day you hear a funny noise from the car's engine. You take it to the garage. The garage man thinks it is nothing much but when you tell him you are insured for repairs his eyes seem to light up and he says that he will take the engine apart just to be sure there is nothing wrong. It's inconvenient and expensive but you want to get your money's worth from the insurance and you are a bit anxious that it might break down so you agree to have the engine inspected. The garage man takes the motor to bits and he finds some of the parts are a bit worn. He replaces these and one or two other components that look a bit suspect. It will all be paid for by the insurance. Everybody is very happy. Except that there are lots of forms to fill in and there is some delay before the customer gets his money from the insurance company. The only odd thing about the transaction is that there wasn't actually a lot wrong with the car in the first place.

It is a very odd thing that when it comes to healthcare as the Americans contemplate moving towards a system more like ours we seem to be heading towards a system more like theirs. What is not being adequately addressed on either side of the Atlantic are the reasons for the enormous and rising cost of healthcare. Keeping the lid on spending while ensuring that everybody gets the necessary care is the forgotten challenge. However you pay for your healthcare you do not want to be paying more than is necessary.

On both sides of the Atlantic there are unseen powerful influences all pushing in the same direction - towards private provision. Somebody is making a lot of money from healthcare. Enough to pay for some rather amusing videos. Keeping a lid on healthcare expenditure is not their aim.


Betty M said...

I do find it astonishing that people in the US really believe that this is how universal health care works in Europe/Canada.

Andy Cowper said...

Morning Dr G. Friends in the motor industry repeatedly confirm that the 'insurance job' business model firmly underpins over-treatment and cost-inflation in their industry. And don't get them started on the con of the requirement to maintain warranty by dealership-servicing of cars (now, fortunately, ruled anti-competitive and illegal by the EU).

Personal insurers always complain that nobody who is burgled or loses luggage ever loses a Timex or a Swatch - it's always a Rolex.

If we apply the same principles to healthcare, why would we be surprised to find the same behaviours?

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