Health is a ‘fundamental human right.’ An effective health system is believed by many to be a critical component in achieving sustainable development, as well as reducing poverty and social inequality. Yet, even as we acknowledge the importance of access to healthcare for all, it raises a very challenging problem for any government: the provision of good quality healthcare for an increasingly ageing population and the chronic long-term conditions that accompany this demographic. How can any system that has a finite number of medical professionals, facilities and budget meet these increasing and potentially limitless healthcare needs?
In addressing this issue governments have adopted a range of models: the Beveridge model, famously adopted by the UK, the NHS – a system where healthcare is free at the point of use. The Bismarck model, originating from Germany, which functions on the basis that everyone must have insurance provided by private companies. The National Health Insurance Model, the Canadian approach that states that everyone must have health insurance, but such insurance is provided by the government. Finally, there is the out-of-pocket model, where patients pay for their healthcare themselves- out of their own money as and when they need it. Whatever the type of system or combination systems adopted by a government, the result needs to be the provision of high quality healthcare for all citizens that is readily accessible to all groups, particularly the elderly, disabled and those living in the rural areas. Yet the potentially limitless demand ensures this question persists: is it possible to provide such services with limited resources?
Can high quality healthcare and the reality of finite resources co-exist? High quality healthcare relies on the input of many resources. Some think that the logical system to achieve this standard of healthcare would be privatization as suggested by pundits. This contrasts with the fundamental idea of Britain’s ‘greatest achievement’- that healthcare is indiscriminative, ‘free’ and accessible for all. We shouldn’t have to compromise the values of the system due to a limited budget, hence we must improve the quality by using the resources we already have and using them more productively.
In the UK, the cost of providing healthcare has been growing at unsustainable rates. Naturally, the pressure to control health care costs has been increasing. The Department of Health estimates that spending in the UK on the NHS will exceed £20 billion and this will in turn reduce the budget available for food, housing, education, national defense, and everything else. A developed country such as UK cannot afford this reduction, as it would result in damage to the wider economy, growth and basic standards of living. Much of the growth in health care spending over the past 20 years is linked to modifiable population risk factors such as obesity and stress. In 2013/14, £112 billion was spent on NHS in England. The percentage of GDP spent on healthcare is the highest it has ever been which has risen by an average of 0.7% to 3.7% per year with expected rise of 1.3% 2015/16. The budget is under increasing strain with shortfall.
Spending for secondary care services (hospitals and mental health) has increased at a faster rate than for primary care and spending on care supplied by non-NHS providers (private, voluntary and local authority organizations) has risen by an average of 6.2% a year. In addition spending on NHS temporary staff has risen at a faster rate (9% per year) than spending on permanent staff (4% a year). These figures are growing at an unsustainable rate posing the question ‘How can we reduce costs?’ To achieve this it becomes vital to eliminate wastage.
One area that could be targeted is reducing number of missed appointments which prolongs waiting time, preventing ill patients from getting the prompt healthcare they need. Furthermore many patients avail emergency services for minor illness which increase the burden on health care services. Developing public awareness and education of this problem and accessing telephone advice center such as NHS direct would help to reduce this burden which in turn would save resources.
It is estimated that £300 million every year is wasted on unused prescription medicines alone. These medicines are also a potential risk of drug abuse and overdose. Developing public awareness by education to reduce availing unnecessary prescriptions, recycling unwanted and expired medications and safe disposal of medicine would help to reduce the cost and risks. By working with the pharmacies, GP surgeries and community workers, this cost can be reduced 60%. Local initiatives such as medicine waste.com have created this awareness successfully and creation of a national programme would improve this awareness further. Programmes such as ‘what a waste’ and ‘Shine’ (which aim to reduce pharmaceutical waste in care homes in Northumberland) have proven to save 50 million pound per year, the money which could be spent on improving efficiency and quality.
Prevention is a key factor that could lead to a more efficient healthcare system; even the Hippocratic Oath states that ‘prevention is preferable to cure’. The resources spent on improving primary prevention of widely prevalent disease such as diabetes, coronary artery disease, smoking induced lung disease, some cancers, sexually transmitted disease such as AIDS and obesity would potentially reduce the prevalence of these disease which are major burden on our health system. About 12.5 billion pounds a year, a large percentage of the NHS budget is spent on illness caused by excessive alcohol consumption, smoking and obesity. The resources spend on the education programmes targeting discontinuation of damaging habits such as smoking, excessive alcohol consumption, recreational drug use, unhealthy eating, and sedentary lifestyle is a good investment in the long term as this will greatly reduce the number of people acquiring the disease. This will save millions of lives, improve the health of the nation and reduce the burden on our services which will help to divert the available resources where it is much needed.
Doctors, themselves, can also be held accountable for some proportion of the wastage in the healthcare system. A report published by the Academy of Medical Royal Colleges suggests that the doctors and other clinicians must be supported and educated to ensure that the resources of the NHS are used in the most effective way possible to provide the best quality and quantity of care for patients. This idea claims that doctors have an ‘ethical duty’ to prevent waste and suggests that by doing so the NHS could potentially save nearly £2bn. However a strong opposing statement to this article is that the primary duty of the doctor is care to their patient. If doctors place a heavy emphasis on reducing wastage they might compromise the quality of healthcare that they provide and subsequently reduce patient satisfaction and potentially risk their lives which renders the initiative counterproductive. An equilibrium must be reached where there is minimal wastage and high patient satisfaction and welfare.
The Media has always played a significant role in influencing public opinion on a wide range of health matters and not always with positive effects. Today the internet is ubiquitous and medical information is easily and readily accessible for everyone. The quality, quantity and validity of this information can cause more harm than good. For example in the 80’s when HIV/AIDS cases are frequently made headlines in England many people refrained from getting tested as they were falsely informed that it was a ‘gay’ disease. This misinformation refrained many affected individuals to obtain early treatment because of social issues. In 1998 an article in a reputed medical journal incorrectly claimed association between Autism and the MMR vaccine. The news spread rapidly and it was widely reported on social media resulting many parents refraining from vaccinating their children. This had an adverse effect on both families and the NHS as the cases for MMR increased rapidly and in 2008 measles was declared an endemic in the UK which increased the burden on health services, more so the health of the community. By setting up an agency of specialist medical professionals capable of rapidly responding to instances of Media misinformation is essential. By promoting people to use well informed online resources and applications such as NHS direct and Glos NHS which advices the user whether they should go the pharmacy, GP surgery or A& E department for their problems, the burden on emergency services can be reduced which will decrease the A&E waiting times. When it comes to healthcare, time is a precious resource and can be the difference between life and death, thus reducing wastage of this resource could drastically improve the quality of healthcare provided to those patients that require it the most.
The community plays a vital part in the lives of many individuals so getting the local population involved in healthcare seems intuitive. Funding and the development of resources such as community care programs and groups could prevent the misuse of GP and A & E Services. Increasing the number of carers, support groups, educational classes and community rehab could lead to a reduction in occupied beds and unnecessary appointments and saves the resources for acute emergencies.
A proportion of the budget must be used to develop non/minimal-invasive technologies that utilize modern imaging machinery such as stent insertion and radiotherapy along with services that are accessible and affordable for everyone. Ultimately the inefficiency in the production of medication and tools has lead to extortionate medical bills. The power held by monopoly producers of these tools and medications has led to the increase in prices of these medicines and machineries. To ensure more resources of the same quality the pricing agreement with pharmaceutical companies should be changed. Investment in research and development should be increased to increase competitiveness in the medical sector. Reducing prices and increasing the range of supplies could improve value for money for the NHS, hence the resources will be cheaper, many of equal or higher standard.
Though the goal of global high quality healthcare for all seems currently unobtainable with limited resources, it is possible by taking steps towards achieving it. Heavy emphasis should be placed on reducing wastage and avoidable costs and the available resources should be allocated in such a way to improve the efficiency of healthcare systems. Major emphasis should also be placed on education, mass information and primary prevention. Investment in research and new technologies and advancements should also be encouraged to improve the quality of the care. All of these factors coupled with the elimination of the profit motive in healthcare systems and firms that provide resources would enable us to provide a higher quality of healthcare with the same limited resources. Patient satisfaction and health would be maximized resulting in productive economies, healthier societies (both physically and mentally) and global progress. Healthcare is the backbone of society, without it a country would fail to exist. If we wish to evolve, improve and progress we must strengthen this backbone, we must provide high quality healthcare with the resources we have.