A fascinating question about womens' health care

Nadia Sawalha has revealed that vaginal birth under the NHS has left her mildly incontinent. In The Guardian we are told that this doesn't happen in France. Women who have given birth in the traditional manner are, there, given a course of physiotherapy including the use of Kegel weights and electrical stimulation of the pelvic floor.

This sounds to us like a very useful thing for a health care system to be doing and the question becomes, well, why do they and why do we not? 

Of course, while the embarrassment or comic potential of this kind of procedure is high, there is a serious point to make. Although electrical stimulation can be prescribed on the NHS, referrals to special “continence centres” aren’t routine. And an estimated 50% of women don’t seek treatment in the first place. But with the necessary, fairly small equipment, this treatment could even be offered – as it is in France – by local professionals rather than at specialist centres.

So, why in the UK are we encouraged by adverts to accept incontinence pads as inevitable when in France doctors routinely prescribe this treatment (as well as physio for the abdomen)? And since when did incontinence get euphemised with the term “sensitive bladder”?

Whether the problem is our inability to talk about it, or simply that the treatment isn’t commonly offered, it’s hard to say. But, if I, as a serial birther, can now leap on the trampoline with glee – surely British women, too, should be offered the chance to swap a few hours of embarrassment for a lifetime of dry knickers?

We would insist that the answer is in the structure of those health care systems. The NHS is, as we all know, a monolithic abhorrence planned along almost Stalinist lines. The treatments on offer are those the bureaucracy thinks should be on offer, in the volume and at the time and place deemed suitable by the bureaucracy.

The financing of the French system is mildly different but it does devolve to government guaranteeing treatment for all. But that guarantee covers myriad suppliers. That is, they have a multiple provider of health care environment. There are for profit suppliers, charitable, government owned, self-employed and just about every other possible and potential form of economic arrangement. All of whom compete for those government guaranteed and insurance company funds as the individual patient picks among suppliers.

That is, they have a market in the provision of health care even if there's a substantial state element in the financing of it. And as happens in markets, however financed, suppliers end up supplying what it is that consumers think best increases consumer utility.

Such as, for example, improving pelvic musculature among post-partum women.

Why do British women not get this routine in other places addition to their health care? Because the NHS. Why do French women get what improves their lives so much? Because not-NHS.

Markets deliver what consumers want as consumers exercise their choices. Monolithic bureaucracies, not offering choices of supplier, do not offer what consumers want. Which is why we want to have, with significant involvement of government in financing and even regulating health care, markets in the provision of health care.

That mothers should be able to partake of carefree leaps upon a trampoline may not be a convincing argument but a lifetime of dry knickers for all mothers seems like a reasonable enough goal. We do already spend 10% of everything on health care and it only needs a tweak to how we organise that spending to reach the goal.