Patient unto death

National health system (NHS) patients must, above all, have an abundance of patience. They have long waiting times for every kind of health-care service. South Africans, who are accustomed to receiving same-day attention most of the time, from both private and public health service providers, would be driven frantic by the national health systems of countries such as the UK and Canada.

A taxpayer-funded NHS is intended to provide everyone with access to good quality health care services, and especially to provide the poor with services that they would not be able to afford themselves or would be reluctant to utilise because of the cost. In SA, extensive health care services, of variable quality according to official reports, are provided to the poor at taxpayers’ expense. They also have access at reasonable cost to SA’s vibrant private health sector. Remarkably, in view of the difference in per capita incomes between SA and the UK, a comparison based on anecdotal evidence appears to suggest that the poor in SA have greater access to health care services than their counterparts in the UK.

Regular reports appear in the UK media describing the problem of queuing for medical and dental services. In September 2005, Zimbabwean dentist Shamiso Ketani opened a practice in Milnrow in the UK. At 9 am on the opening day there was a queue of 150 people waiting in the freezing cold to register with his practice for NHS services. Some of the people waiting in the queue had been without dental services for three years.

On 25 June 2005 Liberal Democrat MP, Steve Webb, launched a scathing attack on the government in the British House of Commons about the queues. He revealed that there was a shortage of 2000 dentists in the UK, dentists in the system complained that they could not provide quality services under the NHS, and an inadequate number of young people were interested in becoming dentists. Dentists were being lured from other countries, most notably Poland.

Webb’s most telling comment was, ‘The Government amendment states that all patients have got a better deal. How can the Minister put her name to it? How has the 70-year-old gentleman from Prestwich got a better deal if he has to queue around the block even to get his name on the list? It is unacceptable, and redolent of what happens in a third-world country. I am embarrassed when British people have to queue around the block simply to register with a dentist.’

The British government has subsequently solved the problem of Steve Webb’s embarrassment: it has banned the queues. Lest I be accused of taking sides in British politics let me hasten to add that the only way the Liberal Democrats could avoid being plagued by the same problems and suffering the same abuse from political opponents if it were to come to power, would be to abolish the NHS. However, a party platform promising to end the NHS would probably spell defeat for any political party. The illusion of ‘free’ medical care is too ingrained, despite the ‘third world’ level of service.

Queues to register with dentists may be embarrassing and make good media copy but the most pernicious queues are those that are not physically visible, as the queues for dentists will now be. They are the lists of people who are waiting for specialist attention, often for urgent life-saving operations, procedures or treatments.

According to a BBC report, Health minister Rosie Winterton recently announced that patients are to begin treatment within 18 weeks after seeing their doctor under new waiting list targets. However, this target period applies only to eight selected areas, with a target date of 2008 for all areas. So it is the chosen few who are to be guaranteed the ‘short 18 week’ wait. A goodly number of these patient British souls are surely at risk of not having their patience rewarded – the possibility of dying before the waiting period elapses must be very real.

Canada has a national insurance system and it is instructive to compare that wealthy country’s waiting times for treatment with the delays experienced by the British. The Fraser Institute’s 2005 Waiting your Turn: Hospital Waiting Lists in Canada reported that the shortest waiting times from referral by a GP to treatment among various specialities existed for medical oncology (5.5 weeks), and elective cardiovascular surgery (8.3 weeks). The longest waits were for orthopaedic surgery (40.0 weeks), plastic surgery (36.2 weeks), and ophthalmology treatment (27.4 weeks). The median wait across Canada for a CT scan was 5.5 weeks and for an MRI scan 12.3 weeks. In some areas of the country in some specialities the waiting times were much shorter but the overall picture is decidedly gloomy.

Finding an explanation for this parlous state of affairs in the health care systems of two of the world’s wealthy countries is not difficult. So-called ‘free’ medical care results in unlimited demand while resources remain limited. Patients have the perverse incentive to utilise as much health care as they can while there is a limit to the taxes or insurance contributions that an elected government can extract from its citizens to pay the resultant cost. The answer to the problem is to limit supply by having patients queue for services as they have to do in the UK, Canada and any other country with some form of national health system.

Queuing is, however, not the only mechanism the UK’s NHS employs to cut down on costs. It has an organisation called the National Institute for Clinical Excellence (NICE) but as one author pointed out, the function it performs is not so nice. This organisation decides what procedures will not be used on what patients. It also decides what medications will not be supplied through the NHS. Naturally, this means that older patients are likely to be denied costly procedures and medications. The committee has the power of life and death, so some patients will never know why they are patiently waiting to die.

Author: Eustace Davie is a director of the Free Market Foundation and of the Health Policy Unit. This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author’s and are not necessarily shared by the members of the Free Market Foundation.

FMF Feature Article/ 21 February 2006


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