….. For starters, the United States should envy the United Kingdom’s commitment to universal access to health care, not because it suggests moral superiority but because it confers a strategic advantage. Only when societies commit to covering all their citizens with their limited resources do they take on the difficult work of improving the value of care. Thus, virtually every major study shows that systems that cover all citizens achieve better outcomes at lower cost…..
….. Universal coverage creates challenges — notably, the rationing that results from competition for scarce funds. But without commitment to universal coverage, it’s too easy to “solve” financial problems by not insuring or underinsuring people. Universal coverage forces discipline. It also shapes social solidarity, community responsibility, and even audacious aspirations. In U.S. institutions, for example, “stroke teams” think about giving great care to people who’ve had strokes. In the English National Health Service (NHS, which is administered separately in England, Northern Ireland, Scotland, and Wales) stroke teams do the same but also think about how to reduce strokes in a given population….
… The English, for their part, should envy Americans for their choices and the competition that drives health care organizations to respond to their needs and wants. U.S. reliance on market principles has created an enormous laboratory, with the best organizations defining what’s possible and “disruptive innovators” shaking up the marketplace….
…. The evidence favoring competition is increasingly inescapable even in England. Last year, the London-based Office of Health Economics concluded that competition can improve the quality of health care and that the entry of new providers “can be an important source of innovation.” England needs that innovation because the NHS lags in responsiveness to patients.Patients in England get what they are given: if their local hospital happens to be Stafford, where a recent investigation confirmed that the care was “appalling,” or they can’t get a general-practitioner appointment for a fortnight, that’s just bad luck…..
…. The best U.S. providers gain a large market share because they earn patient loyalty through great outcomes and service. We see no reason why universal access should conflict with choice and competition. More choice and competition would not undermine the commitment to coverage in the NHS, but it might improve access and quality…..
…. The overall U.S. system is weak but allows strong organizations to thrive; the English system is strong but weakens the organizations within it. In other words, the U.S. system is too “bottom-up,” and the English system too “top-down.” The U.S. system encourages providers to think outside the box, whereas the English system encourages providers to regard themselves as part of a broadly defined community, but one in which change is harder to imagine…..
…. Each country has strengths to be proud of and weaknesses that demand humility. Translating the best of each system need not mean transplanting the worst as well: a synthesis of the two systems could conceivably cover everyone, offer choice and competition, blend bottom-up creativity with top-down strategy, and integrate services so that patients get the right care in the right places. In the future, English and U.S. health care organizations could compete for patients on the basis of the integration of delivered care….
“I suggest reading the whole article. It is food for thought.”