Term Paper on "British Healthcare System: A Model"

Term Paper 6 pages (2194 words) Sources: 30

[EXCERPT] . . . .

British Healthcare System: A Model for the United States?

Are there components in the British National Healthcare system (NHS) that would fit well in the United States national healthcare system? This paper reviews and critiques scholarly, peer-reviewed research on several aspect of the NHS, noting which of those may or may not be appropriate in the United States.

An article in the journal Medical History (Stewart, 2008, p. 453) posits that the original idea behind the NHS was not "a national health service at all" but rather it was a "national hospital or a national sickness service." The focus was on treating injuries and sickness, Stewart insists, and preventative medicine -- along with public health education -- were "relatively neglected" (p. 454). Meantime, Stewart admits that though the growth of NHS expenditures "was ahead of the rate of growth of the economy as a whole," the era of the NHS "…has seen a steady improvement in the health of the British population" (p. 457). Any system instituted in the U.S. (whether identical to the NHS or not) would need to improve the health of Americans but if its cost became a huge albatross on the U.S. economy it could negatively impact other vital services. Also, an American system would need to begin as a preventative as well as a curative system.

Sixty years after the NHS was enacted, Martin Gorsky writes in Social History of Medicine that NHS at the outset (1948) was a "fairly stable institution" which then entered an era of "sustained reform characterized by the incursion of market disciplines" (p. 440). It has become a "monolithic" service, Gorsky continues, and evidence of that is the exponential growth of hospital staff -- expanding from 400,000 in 1951 to 1,166,000 by 2004. The NHS has evolved in a way that a U.S. system would certainly attempt to avoid: to wit, Gorsky asserts the NHS transitioned from "paternalism and technocratic planning…to the ceding of professional autonomy by clinicians to managers and to the state" (p. 437).

Employees in the NHS -- like employees in any workplace -- were seeking a higher level of job satisfaction in 2000 at the same time the NHS was entering into a process of modernization. But in their article, Colin Fisher, et al., assert that employee perception of job satisfaction may have acted as "a barrier to modernization" (Fisher, et al., 2004, p. 304). Survey questionnaires were given to all employees of two trusts and were returned by 1,289 infirmary staff (24% of the staff) and by 1,535 General Hospital workers (25% of the staff). What those questionnaires indicated was that while 90% of employees believed it was important "for the trust to give leadership about its vision" but a very low percentage (41% in the Infirmary and 40% in the General Hospital) understood what the vision / policy that leadership was putting forward (Fisher, p. 309). The "failure of communication" that led to a misunderstanding or a lack of understanding of the direction leadership was taking staff would not be helpful in the U.S. If American leadership. In the matter of the NHS, or in a U.S. healthcare system, why would employees embrace modernization if they were not sure where leadership was taking them?

An important element of NHS is dental care, which would also be a welcomed aspect to any government-supported healthcare program in the U.S. But in the NHS the rising cost of providing dental services to British citizens was not able to be contained even by implementing more efficient and effective accountability standards (Jessop, et al., 2000, p. 617). Several ideas have been put forward with the hope of cutting costs for dental services; one of those ideas was to establish outreach dental clinics and another was to introduce Primary Care Groups (PCGs). Still, "unless GDPs (general dental practitioners) are allowed, willing and able, to participate in" the primary care groups, dental services could be "pushed to the fringe of NHS care provision" (Jessop, p. 617).

Meanwhile a research article investigating the quality of dental service in the NHS reports that when it comes to root canal treatment for British patients, some dentists "are using the techniques taught during their undergraduate careers," but a "large percentage" (as of 2001) "now use techniques with no evidence of clinical effectiveness" (Jenkins, 2001, p. 16). A survey of 720 dentists in 1991 indicated "marked differences between [dental] centres in the UK and in other countries" (Jenkins, p. 16). If the U.S. were to adopt a universal dental healthcare program similar to the NHS model and "many dentists fail[ed] to practice techniques regarded by clinical teachers as fundamental to successful treatment" there would be an outcry and a government investigation (Jenkins, p. 17).

Another article referencing dental services in the NHS indicates that many general dental practitioners in the UK work as "independent contractors" and that "dentists' attitudes revealed considerable ambiguity towards the NHS" (Lynch, et al., 2003, p. 309). The healthcare plan that is emerging in the U.S. does not address dentistry specifically, and prior to any such plan being developed it would behoove U.S. legislators and healthcare professionals to examine the dental care situation in the NHS. Why? Dentists are reducing their work for the NHS and "increasing their private work" which is more lucrative than being a contractor for NHS -- and as a result there has been "a significant reduction in public satisfaction with general dental care" (Lynch, p. 309). An NHS survey questionnaire was sent to 2,000 dentists but only 51% (1,011) completed the questionnaire; of those, only 895 questionnaires were full completed. Still, those that were completed showed 19% of respondents treated NHS patients exclusively and 63% treated no more than 10% of their patients in a private dental setting (Lynch, pp. 310-311). Reasons for treating private patients rather than NHS patients included: spending more time with the patient (67% agreed); more choice for the patient (62% agreed); "having more control over clinical decisions (57%); and maintaining financial security (31%) (Lynch, p. 314).

An article in Health Economics (Chalkley, et al., 2006, p. 933) posits that "financial incentives" are "important determinants of physician behaviour" and that self-employed dentists treat patients that are "exempt from payment" more "intensively" than dentists who are salaried through the NHS. This is a potentially ticklish matter that should be taken into account in the U.S. As new healthcare reforms are instituted; e.g., should financial incentives be a part of any reform of healthcare in the U.S. Medical ethics is part of the issue here, as Chalkey explains; and moreover, a desired level of service from dentists can be expected when the "quantity of services" is tied to the method of payment to the dentist (p. 933). This seems logical, given that if a customer takes her automobile into a service station to have four issues resolved, she will expect to pay more than if she were just having a headlight changed. Sometimes what seems like an obvious answer to a problem can become convoluted when government (and politicians) becomes involved; these NHS issues should be homework for U.S. administrators preparing healthcare service reforms.

"…What can the United States learn from the NHS?" (Kerr, et al., 2009, p. 1) According to the article in the New England Journal of Medicine, the "jewel in the NHS crown is the strength of its primary care and its general practitioners" (Kerr, p. 2). Today, following reforms to the NHS, Britain's doctors concentrate on the whole person (rather than "on a single organ") and that has helped to reduce the life-expectancy gap between the wealthy and the poor ("currently about 13 years in Britain") (Kerr, p. 2). The article asserts that 86% of medical needs in Britain can be met by the community health centers, hence the need to send the patient to a specialist is greatly reduced, Kerr goes on. In the U.S., primary care is an area of "relative weakness," according to Kerr, and this is clearly an issue that will need to be resolved when the U.S. healthcare reforms are fully ironed out.

One of the most dangerous aspects of providing managed healthcare services is transferring critically ill patients from one hospital to another. An article in the Emergency Medical Journal (Ahmed, 2008, p. 502) explores the risk management strategies that are in practice in NHS hospitals, an issue that the U.S. healthcare professionals should pay close attention to in terms of learning from the positives and negatives of the NHS. When transferring critical ill patients, hospitals should provide a "dedicated transfer trolley, protective clothing, fluorescent jacket, boots, mobile telephone and insurance cover," in that order, according to Ahmed (p. 502). However, "NHS hospitals are clearly falling short of these legal requirements" and in some cases NHS hospitals are "…in breach of national guidelines governing the issue" (Ahmed, p. 502).

The author mentions (p. 503) that "most transfer patients (58%) are accompanied by junior trainees in anesthetics" and sometimes these junior staff have but 2 years… READ MORE

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