Comparing apples to apples: NHS still ranks below average
Most healthcare reporting is deeply biased. From blogs to papers to policy, most people have strong preferences for different kinds of healthcare systems that they believe to be ‘the best’, often based on what they view the role of the state to be. Obviously some beliefs are grounded in more facts and stats than others, but given how complicated healthcare systems are, it’s possible to come up with all different kinds of conclusions that appear, at least on the surface, like they’re grounded in fact. Compare, for example, The Commonwealth Fund 2014 report to the 2014 European Health Consumer Index: two studies that compare international healthcare systems. Both published within one year of each other, The Commonwealth Fund ranked the NHS the best healthcare system out of 11 countries, while the EHCI threw it down the list, ranking it 14th after all your obvious competitors, including The Netherlands, Switzerland, Germany, but also after your less obvious contenders, like Portugal.
Both reports appear to be thoroughly researched and have lots of numbers to back them up. So who do you believe? Well, if you favour single-payer health systems, you're probably going favour the Commonwealth Fund's report, which inherently favours centralised systems. (For example: out-of-pocket costs and insurer rejection of full cost reimbursement were considered a black mark against a healthcare system, regardless of access to treatment.) If you rank results higher than the principles around who delivers healthcare or who makes a profit, you're probably going to favour the EHCI's report, that gives more weight to things like waiting lists.
I personally give more credit to the EHCI report because my primary concern when it comes to healthcare systems is patient outcomes. That’s my bias.
Which is why the OECD’s healthcare efficiency reports are so important. The OECD’s stance is that “there is no “one-size-fits-all” approach to reforming health care systems. Policymakers should aim for coherence in policy settings by adopting best practices from the many different health care systems that exist in the OECD and tailor them to suit actual circumstances.” So while the OECD does make some comparisons of countries across the board, it also intentionally group countries together based on different kinds of healthcare systems in order to compare like with like.
Specifically, they break countries down into six groups to compare the efficiencies of similar healthcare institutions to each other, in an attempt to identify where the most improvement can be made within specific systems:
The UK falls into Group 6, which is characterised as:
Mostly public insurance. Health care is mainly provided by a heavily regulated public system, with strict gate-keeping, little decentralisation and a tight spending limit imposed via the budget process
Seven countries fall into this category: Hungary, Ireland, Italy, New Zealand, Norway, Poland, and the UK. The OECD uses nifty radar charts (click on links) to illustrate how each country compares to both the OECD average as well as Group 6’s average in different areas including efficiency and quality, amenable mortality, prices, resources, consumption, financing and policy. The final chart ranks each country’s to measure its comparative efficiency. The results:
High DEA Score: Norway, Italy Above Average: Poland Average: New Zealand Below Average: UK Low: Hungary, Ireland
The OECD’s analysis: “The quantity and quality of health care services (in the UK) remain lower than the OECD average while compensation levels are higher. Reinforcing competitive pressures on providers could help mitigate price pressures, e.g. by increasing user choice further and reforming compensation systems.”
On Tuesday I noted that the UK is one of the OECD countries that could do the most to improve its efficiency in public healthcare spending . But breaking that down even further, the UK doesn’t come close to topping the charts in its own group.
Perhaps the UK should be looking to make improvements to resemble Norway, which tops the ranks for public health services. Or maybe it should be looking towards other categories that focus on social insurance systems. Either way, it's time for the UK to start looking beyond the NHS.
Let them eat cake...and buy discounted TVs
Already (and keep in mind they’re five hours behind), Americans are storming Wal-Mart, Best Buy, Macy's (and a whole lot of small, independent shops too) to snag the best Christmas deals of the season. It’s Black Friday- the biggest shopping day of the year in the States, when stores open ‘early’ and offer huge discounts on otherwise pricy, luxury goods. Unlike the Brits, who started looking forward to Christmas post-Halloween, Americans had to at least pretend they weren’t listening to Bing Crosby on their iPods until the day after Thanksgiving; and now, with less than a month till Christmas day, shoppers will spend well over $1billion today alone to make up for their tireless waiting.
Over the past few years, this all-you-can-shop American trend has spilled over to the UK, with Amazon, Apple and Wal-Mart’s Asda taking the charge to bring discounts, up to 70%, to British consumers. Still in its early phases of becoming any kind of British tradition, the demand from customers for these kinds of deals continues to sky-rocket; last year, according to Visa’s estimate, £1million was spent on its cards every three minutes, and it’s expected this year’s charges will be up 22%.
And this year’s looking even bigger:
However, this year, the day is expected to be even busier. Black Friday 2014, scheduled for November 28, should be the biggest online shopping day ever in the UK.
Christopher North, managing director of Amazon.co.uk, said: “Black Friday took an incredible leap forward in 2013 with so many more customers taking advantage of the great deals on that day, resulting in sales of over 4m items for the very first time in our history.
“This year, we are offering more deals and savings than ever before and we are expecting record numbers to benefit from Black Friday Deals Week.”
Some take a moral stance against Black Friday, arguing that it promotes consumerism and unnecessary purchases; and some in the UK have gone so far as to say it defies British identity, as Black Friday has, until recently, been a post-Thanksgiving, US tradition.
It seems almost too obvious to point out that the the millions of pounds that will be spent in the UK today are a huge boost to business; benefiting not only businesses and their employees, but the customers themselves who are able to buy electronics and goods they could not otherwise afford at hugely discounted prices. It's all very well to claim the moral high-ground on consumerism if you and your family want for nothing; but for many customers, necessities in the digital age (like computers and phones for their kids) aren't accessible at their normal prices.
As for British identity - Black Friday is far too new to the UK for us to know how it–as a sales pitch or as a tradition–will play out in the future. Under no circumstances should Britain adopt the crazy shop-till-you-drop celebrations if it doesn't want to; but no one can deny the huge, and ever-growing, demand from British consumers for the Black Friday tradition. And as long as there's demand, let the rush commence.
Isn't it EUronic
I actually can’t tell if they’re kidding or not. From the BBC:
The UK has been told it must pay an extra £1.7bn (2.1bn euros) towards the European Union's budget because the economy has performed better than expected in recent years.
Replace ‘UK’ with ‘worker’, slot in a different extremely high number, change ‘EU budget’ to ‘UK budget,’ and the system starts to resemble something quite similar to tax law in the UK.
The article continues:
The payment follows new calculations by the EU that determine how much each member state should contribute.
It would add about a fifth to the UK's annual net contribution of £8.6bn.
A government source said the demand was "not acceptable" while one Tory MP said the UK should simply refuse to pay it.
“UKIP leader Nigel Farage said the UK had been "hammered again" while Labour said it was imperative that the European Commission must reconsider the "backdated bill".
It appears UK politicians are in complete shock that hard work and serious efforts to pull out of the recession are being threatened by a big, bureaucratic government body that feels it’s entitled to some of those earnings.
This is priceless.
On the issue itself, I agree it’s “not acceptable”, and I dearly hope the UK “simply refuse(s) to pay it.” What a wonderful precedent that would set for next year’s tax season, when hard-working taxpayers (who, according to this year’s stats, will have been working for the Chancellor for 148 days to pay off their obligations), decide that they, too, don't want to be penalised for working harder and being a bit better-off financially.
Politicians can be slow on the uptake, so I guess there’s no deep surprise that it took them this long to understand the mechanics of ‘hard work = rewards.’ I just hope they whistle the same tune come next tax season.