Th Ways of National Health Service Funding - Term Paper Example

NHS FUNDING Introduction World Health Organization defined health as of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 1946). Being such, governments are “responsible for enabling their population to achieve better health through respecting, protecting and fulfilling rights” (Gruskin et al 2007, p 449). Hence, health as a basic human right has been seen as necessary if human flourishing is to be attained and achieved by the citizens or the general populace of a particular society. Within this new paradigm, health care systems have been established in order to respond to the mandate that health is a part of the basic human rights. However, for each health system to be able to provide the most efficient and sustainable means in attaining the well-being of the individual and the community where he /she belongs, the condition and context with which the health system is embedded, functioning should be considered. Thus, it can be assumed that health care system by its nature is the coming together of socio-political-cultural-economic-legal-health factors and conditions that affect and influence the delivery of health care within a particular society. This particular assumption regarding the nature of health care system stems from the fact that health in the contemporary period is no longer just confined in the doctor /patient relationship but is also concern with the quality of life of the entire population. Within this particular view, it is not surprising that the problems which, health systems encounter are considered as primordial interest and of particular significance both to the government and the citizens. In light of this, this paper intends to look at one of the most important problems that confound the National Health Service in England today – funding. The Problem Funding has always been the concern of all, especially, governmental agencies that provides services to the people, and the National Health Service in England is no exception. Funds are necessary in the operation of NHS since the primary objective in the creation of the National Health Service (NHS) “was to create equality of access to health care, principally by making it free at the point of delivery” (Bevan & Robinson 2005, p 60). This objective is translatable concretely by the idea that NHS funded care is used and is accessible by the majority of the population (Dixon et al 1991). However, this objective can only materialise and be accomplished with the presence of funds to be utilized in carrying out this objective. Without funds, this primary objective of NHS is good only in the papers, nothing more, and nothing less. Being such, source of funding has always been one of the major concerns of NHS especially now that the world today is facing a global crisis. The Options During the late 80’s the problem regarding the possible sources of funding for NHS has already been discussed. Klein (1988) has already laid down in his article the possible options that may be utilised in securing funding for NHS. According to Klein (1988), three options are basically open to NHS. The first is user charges, the second is specific tax for NHS and the third is private insurance. The fourth option which is more encouraged today as a result of globalization is the public-private partnership (Gaffrey et al 1999). The first option is the user charges. It has always been considered as a viable option. However, there are certain arguments and counter arguments for user charges as the source of funds for NHS. For the argument in favour of user charges, it is claimed that such a policy will “bring more revenues, make patients cost conscious, and deter frivolous demands” (Klein 1988, p 734 – 735). And the counter argument against these are that it affects the hardest the poorest, it is “offending against the principle of equal treatment for all regardless of means, and are liable to have perverse effects on costs by deterring people from seeking early treatment and so discourage preventive medicine” (Klein 1988, p 735). The second option is the creation of specific tax for NHS since currently NHS is funded from general tax. Public opinion seems to favour this option, “public consistently agrees that more should be spent on the NHS and it says it is willing to pay more tax for it” (Dixon et al 1997, p 60). However, there is some reservations to it in view of the fact that, it has been noted that under this particular strategy the heavy user of the health service are the ones which have the least ability to pay for the tax. Being such, it results into an asymmetry that maybe deemed to unfair (Klein1988). Moreover, it has also been asserted that under this particular scheme, there is a possibility for the problem of transparency to be aggravated since the initiative for public participation in policy decision-making is concretely entrenched in the English system with the presence of Citizen’s juries since the 1990’s. The third option which is the private insurance strategy is similar with what is implemented in the Unites States. Under this scheme, NHS will compete with other private health insurance and that the citizens will enrol on who can provide the best service to them. (Klein 1988). Several advantages are gleaned from this strategy namely that it pumps up competition, it opens choices for the people and that since there is competition in the market chances are there will be an increase in the delivery of health services. However, the problem with the private insurance strategy is that it does not provide sufficient evidence that it will increase the funds of NHS and that it will make health services delivery more effective and efficient (Klein 1988). The fourth option is the public-private partnership strategy. This scheme is basically already at play in NHS. As one of the strategies undertaken in the reform of NHS is the “modernizing of infrastructure” (Stevens 2004, p 38) which implies that there is a tie up between the private and the public which comes into the form of “Private Finance Initiative schemes for building new hospitals and refurbishing old ones: under these schemes, the private sector finances, builds, and maintains the hospitals in question” (Klein 2006 p 410). Being such, it can be inferred that under this scheme the “private sector provides the services and the public sector purchases and funds them” (Gaffrey et al 1999, p 250). However, the basic concern with this scheme is that “capitalism and citizenship represent very different values: the former inequality and the latter equality” (Bambra et al 2005, p 188). These four strategies are the possible sources of increasing the funds of NHS. But the question is which of these will be apt in responding to the problem of scarce resources of NHS? The Choice I honest believe that there is no one specific way or policy to increase the funds of NHS. What in fact is necessary is combination and balance of all the options - user charges, tax and private insurance and hold at a minimum level the public–private partnership. The reasons why I am going for the combination and balance of all the options are: First, health is the concern not only of the individual patient and doctors but that it is a social concern with the government and health providers directly responsible in securing and protecting the health of the people. Being such, there should be a “cooperative behaviour and relationship built on overlapping values and trust” (Childress et al 2002, p 170) among all stakeholders. In other words, all of us are responsible in assuring the “conditions in which people can be health” (Childress et al 2002, p 170). Second, by utilising user-charges, tax and private insurance, the public is empowered in terms of choices, individual’s autonomy is affirmed in the sense control to his own health and options for choices are opened for him/her, and solidarity within the community is also asserted as taxes becomes the form with which we affirm our effort to share the burden of alleviating the suffering of the least privilege and capable in the society. And at the same time, it challenges NHS in particular and the government in general to be true to the tenets of public involvement in health care as “public services are paid by the people ... increasing public involvement will make service more responsive to the individuals and the communities who use them” (Florin & Dixon 2004, p 159). Third, with the individual, the public (communities), private corporations and the government become stakeholders in health care itself, agendas towards attaining “sufficient information, opportunity for respondents to reflect and deliberate and the recognition of the scarcity of health services resources” (Mooney & Blackwell 2004, p 78). Being such, the concern with health becomes a concerted effort of everybody. Fourth, the minimal-level of participation of the private sector is necessary as there is a debate regarding the extent of its involvement in the public sector because there is a clear conflict of interest in the role and participation of the private sector on projects that directly affect the public sector (Dixon et al 1997; Klein 2006). And, the fifth argument that supports this strategy is that there will be caution among the managers and leaders of NHS in disbursement of funds, and a challenge for more transparency, accountability, and justice in the equitable allocation of health care resources. This is necessary as NHS is criticized for utilising the funds in such a way that “the use of resources was haphazard and inequitable” (Sims et al 1997, p 382). At the same it poses, a challenge to managers and leaders that they should be very conscientious in the redistribution of funds as first it is peoples’ money. Second, resources are always scarce and third the redistribution of the scarce resources will always be a problem. Although, I think that these are the steps already undertaken by the government in securing funds for NHS but what I would like to add is that sometimes we focus too much on the money when in fact “it is not always the question of money, but of whom you can get to do a difficult job” (Firth-Cozens & Mowbray 2001, ii6). With these general benefits in mind, we now try to see how it may affect the service users, the provider and the system. The Service Users It can be impugned from the objective of NHS that the heart of NHS, is service to the people – “equity of access to health care, principally by making this free at the point of delivery” (Bevan & Robinson 2005, p 60). And that the service to the people agenda weaves both the spheres of the individual-doctor and the public health. In this scenario, the public becomes an active agent in the pursuit of what is deemed to be for their own good. People’s personhood, dignity and autonomy is respected and affirmed as they themselves take an active role, bears the responsibility of making the decisions and choices necessary for the attainment of their health which is one of the requisites in achieving the good life. In lieu with this, public participation in the decision-making of policies that affect and highly influence their access of health care is necessary if empowering the individual with regards to his/her health becomes one of the aim of health care service. This impetus of the democratic public participation deconstructs the top-down approach to policy making and creates the framework where the experts and the public meets and enter into an arena where dialogue is encouraged (Doyal 1998). This becomes a necessary ethos as it is now fully recognised that the individual well-being is central in the pursuit of health. The Providers This kind of funding scheme where all stakeholders are responsible not only for the resources but for the policies and decision making, reconstructs the health care giver/doctor and patient/community relation. We do not deny that doctors are the primary persons responsible for health, but under this scheme the patients themselves become responsible for their own health. The doctor –patient relationship is transformed from a paternalistic relation wherein we are left in the dark and that the only mandate for the patient is to follow the doctor to a relation wherein both the doctor and the patient become partners in the pursuit of health. Thus, in this new relationship empowerment and human flourishing both for the doctor and the patient is attained. This kind of relation where the providers are not acting paternalistically but are acting as co-journeyers in health affirms the human dignity and autonomy of both the patient and the doctor. At the same time, it removes the misconception of health as “Health is something that doctors are responsible for, they are the providers, and we are the recipients. Their authority and responsibility over health has further emphasized its commodity status—when ill, an individual visits a doctor and/or purchases drugs (commodity) to regain health (another, albeit less obvious commodity). Ill-health is a transient state caused by the presence of disease. It can be ended by the appropriate application of medical technology. This depoliticization of health, via the transfer of power and responsibility to these professional and/or commercial groups, means that we do not acknowledge our power over our own health or our autonomy over our own bodies. (Bambra et al 2005, p 191) Being such, the providers relation with the service users enters into a symbiotic relation (as I have stated above) respects the autonomy of the patient and the doctor and thus health in itself becomes the vehicle for the empowerment of people. The System Although NHS is confronted with many problems, it should also be noted that “the national service frameworks have significantly improved the quality and timeliness of service delivery” (Maynard & Street 2006, p 906). However, it should also be noted that although there are pockets of success in NHS there are still many problems that confounds NHS like rationing of services, availability of patients’ beds, care of the elderly, “poor prioritising of people in waiting list, ineffective treatment being offered, continuing evidence of large variations in treatment rates” (Dixon 1997, p 59) and other similar problems are still haunting NHS. In light of this, NHS and its managers should be reminded of three factors: one is that “it is not always a question of money but of whom you can get to do a difficult job” (Firth-Cozens & Mowbray 2001, ii6). In other words, leadership matters a lot. And the other factor that NHS should constantly guard is to “resist the temptation to reach for the old panacea of reorganization”. And finally, there is a need for “data collection” (Maynard & Street 2006) so that NHS can better improved its services. NHS has to hurdle many things but in the midst of these hurdles, we should also be reminded that NHS despite its problems “has improved services” (Maynard & Street 2006, p 906). Conclusion The problem of the scarcity of resources and its equitable allocation are a constant problem that NHS has to face. With this fact, the combination and balance of the user- charges, tax, private-insurance and the minimal level of public sector-private sector should be utilised as the strategy for sourcing funds for NHS. However, this scheme demands that all stakeholders take an active participation and bear responsibility for the agendas, policies and decision-making in matters that concern the pursuit of health for everyone. References Bambra, Clare, Fox, Debbie, & Scott-Samuel, Alex. (2005). “Towards a politics of health”, Health Promotion International, Vol. 2, No 2, pp 187 – 193. Bevan, Gwyn, & Robinson, Ray. (2005) “The interplay between economic and political logistics: Path dependency in health care in England”. Journal of Health Politics, Policy and Law, Vol. 30, Nos 1 – 2, pp 53 – 93. Childress, James F., Faden, Ruth R., Gaare, Ruth D., Gostin, Lawrence O., Kahn, Jeffrey, Bonnie, Richard J., Kassm Nancy E., Mastroianni, Anna C., Moreno, Jonathan D., & Nieburg, Phillip. 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