问答题 Looking at how far we'll be able to fund the Health Service in the 21st century raises any number of thorny issues. (46)Many of the options have already been rehearsed in the press: excluding some treatments from the NHS, charging for certain drugs and services, and developing voluntary or compulsory health insurance schemes.
Compared to its European Union counterparts Britain operates a low-cost health system: we spend about 7 per cent of GDP on health, compared with 9 per cent in the Netherlands and 10 per cent in France and Germany. In terms of health outcomes versus spend, we compare pretty favourably.
I don't see private health care providing much of the solution to current problems. (47) More likely is a shift from universal health coverage to top-up schemes which give people basic health entitlements but require them to finance other treatment through private financing, or opt-out schemes which use tax relief to encourage individuals to make private provision. Neither is close to being implemented, but the future could see a deliberate shift of attention to voluntary health .insurance and an emphasis on social insurance.
(48) I expect individuals to take greater responsibility for their personal health using technology that allows self-diagnosis followed by self-treatment or home care. Even so, higher taxes will plainly be needed to fund health care. (49) I think we'll eventually see larger NHS charges, more rationing of medical services and restrictions on certain procedures without proven outcomes. Stricter eligibility criteria for certain treatments are another possibility.
All such options would mean a sharp break with tradition and political fall-out that could be extremely damaging. (50) None of them is going to win votes for the political party desperate enough to introduce them but then nobody is going to vote for ill-health or an early death either.