NHS: Let No Good Hospital Go Unpunished

This one's about a month old, but still worth comment. In early August, Telegraph.co.uk reported that Britain's National Health Service (NHS) is punishing hospitals that don't make patients wait for care.

Since the NHS is bleeding money, the bureaucracy wants hospitals to observe minimum waiting times for non-emergency care (e.g., 122 days) as a way of limiting expenditures. Hospitals that do not impose those minimum waits -- i.e., that treat each patient as soon as they can -- lose funding. According to the Telegraph, "One gynæcologist said that he spent more time doing sudoku puzzles than treating patients because of the measures." One hospital was penalized £2.4 million for eliminating their waiting lists. All this is happening while the Labor government has promised to reduce waiting times.

It's not that the minimum-wait policy is so outrageous -- given the task of the NHS. It's that the task itself is outrageous and guaranteed to produce such perverse results. As the Telegraph editorialized:

This bizarre situation arises from the Government's pseudo-market system, which creates conflicting objectives for "purchasers" (PCTs) and "providers" (hospitals).

In a real competitive market, increased demand can allow prices to rise, thus increasing profits, which allow the market to grow. Efficient producers can then reduce their unit costs and their prices, and so give a better deal to the consumer. The prevailing logic is that the more customers who are served - or products that are sold - in a given period of time, the better the business does.

But PCTs have budgets that are predetermined by Whitehall spending limits, and there is no way for them to conjure extra revenue out of the air or to grow their market. As a result, the hospitals that are most successful in providing prompt treatment are running through the finite resources of their PCTs at an unacceptably rapid rate.

So the NHS is faced with a perverse outcome: hospitals providing precisely the kind of immediate access to treatment that patients want and that Government ministers profess to demand, are punished financially by another arm of the Whitehall machine. Any government that wants to reform NHS funding will have to address this conundrum that lies at the heart of a tax-funded monopoly healthcare system.

Britons are lucky that they can opt out of such a perverse system -- but that's only if, as Jacques Chaoulli observes, they are lucky enough to be able to pay twice.