The BMJ on the NHS - Depends upon which numbers you use really
An interesting little example of how it does so depend which numbers you use. The Telegraph tells us that:
Britain's health service is lagging behind that of other high-income countries, research suggests.
The study by the London School of Economics and Harvard School of Public Health compared
ten countries, examining spending levels, and a range of indicators measuring quality of care,
That is rather going to depend upon which ten countries are compared.
Researchers compared the UK with Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland and the US, using data, some of which came from the Organisation for Economic Co-operation and Development (OECD).
The UK was found to have the lowest healthcare expenditure per person at £2,978, compared with an average of £4,438 in the other countries.
Overall, the UK spent approximately 8.7 per cent of GDP on health in 2017, compared with the average of 11.5 per cent.
Ah, yes. So, if we include the US - which spends vastly more than anyone else - then our averages are going to be rather high. Which is how we get to the NHS being the poor orphan having to ask for more gruel. Except that’s probably not the correct message to be taking from this. In the paper itself:
The UK had the lowest healthcare expenditure per capita relative to our comparator countries (UK, $3825 (£2972; €3392); study average, $5700), although this was roughly in line with the average healthcare expenditure of the OECD member states ($3854) and the EU member states ($3616)
That is, if we drop the US from our list of comparator countries the NHS is no longer the fiscal beggar.
Total per capita spending on long term care in the UK was below the study average, but slightly above the average long term care expenditure across the OECD and EU. Social spending in the UK as a percentage of GDP was 19.6%, which was similar to the study average of 20.1% but above the OECD average (16.9%) and the EU average (18.8%).
That paucity of cash for the NHS and social care simply isn’t there when comparing the UK with other European societies. It being possible, we think, to agree that the US is the wayward character in these matters? Thus it being useful to exclude it from the averages we’re going to use to judge the point?
All of which does give us a rather different policy point. Including the US as a comparator gives us quick, quick, we must shovel more cash into the NHS. Restricting ourselves to actually similar countries tells us something different. Given that we’re spending about the same amount, possibly a little more, why is it that we’re not getting results as good? Perhaps, whisper it though we must, there’s something wrong, inefficient, about the manner in which the NHS spends the money it does get?
Our view is much closer to that second of course. Stalinist bureaucracies are not efficient. But it does all rather matter which set of numbers you start with before considering the point, doesn’t it?