October 19, 2007

The last bastion of socialism

The NHS is simply too big. You cannnot have an organisation that big without huge diseconomies of scale.

A big organisation means a big hierarchy, a big heirachy means big waste. Break things up into smaller chunks, responsible to the patients that they serve, and you can reduce the amount of bureaucrats in the heirarchy while making no difference to the amount at the front line. Less hierarchy, less waste.

Any increase in funding has to filter down through, and get dispersed amoungst, few layers before it reaches the front line, and any new ideas have to filter up through fewer layers of people who's job it is to say 'no' before it reaches the person that can say 'yes'.

Defenders of the NHS always wave the straw man that you can either have the NHS or the american model, and nothing else. There is not a black and white choice between the centralised state controlled model of the NHS, with centralised and state controlled system having been proven to fail in every other field they have every been tried, and the US system of a majority private system with the problems apparent there. There are many ways to break it up and make it managable, for example:
The Singapore model where the state will pay for the big stuff but leaves financing the small stuff up to the individual.
The Swedish model where healthcare is part of local government.
The Social Insurance schemes used elsewhere on the continent, such as in France.
Contracting clinics from external organisations, as is used within the NHS for GP clinics and Prosthetics.

Big centralised state controlled monopolies have been shown to be a very bad way of organising in every other field they have been tried when compared to the alternatives. Why should healthcare be any different? Don't like the US system? Try a different one. Perhaps if it where patients that where the most important thing, rather than government dictats, there would be more done based on clinical need rather than in order to massage the figures to fulfill the required quotas and so less patients dieing because of it.


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