For several weeks now, the news has been dominated by the failing NHS. I’m not keen on making predictions, but am willing to stick my neck out – this issue will loom large for the foreseeable future, because there is no obvious mechanism for resolution.
A hysterical politically polarised shouting match rages in the public square about the future direction of healthcare in the U.K.
Most rational observers and participants accept things can’t go on like this, and the best outcome would be to change our current system to one more like the European social insurance model, with a mixed healthcare economy.
The problem of course is that there is no mechanism or clear pathway to arrive at that destination, due to a lack of political and institutional consensus.
In previous articles, I have tried to explain to readers some of the road-blocks to reform within our current system: structural problems, legacy problems and the plethora of hidden agendas. In the short term I think we are heading for the worst possible outcome – a two tier system by default. Those who can pay will be exploited by insurers and private hospital providers. Those who can’t will continue to receive a failing NHS service. Interest in both private health insurance policies and the self-pay sector of the private market has increased significantly, and will continue doing so as the NHS collapses.
I will briefly discuss how the private health system currently works in the U.K. It is a fragmented and opaque market – even more so than the NHS – and very difficult for non-medical people to understand. I should start with a trigger warning: a lot of readers probably aren’t going to like this, and you probably won’t like it if the current model of private healthcare becomes a major feature of life in this country. I have worked in the private healthcare sector for 20 years, the last seven in full-time private practice. I have also had 20 years of interaction with healthcare insurers as both a practitioner and as a customer – I don’t have a good word for any of them. There are some things the private sector does well, but the overall model is highly unsatisfactory for many reasons.
By necessity, this piece will be a very high-level analysis of a complex subject. If there is sufficient interest among readers, I can write more specifically focused granular articles at a later point.
The private healthcare economy can be separated into the following categories. Healthcare ‘providers’, defined as hospital or clinic chains, regulated by the Care Quality Commission (CQC); healthcare insurers, regulated by the Financial Conduct Authority (FCA); healthcare practitioners; individual physicians and surgeons, regulated by the General Medical Council (GMC); and the ‘market’ – all the people wishing to purchase private healthcare. The market as a whole is regulated by the Competition and Markets Authority (CMA). Confused yet? If not, you will be.