International perspective on mixed health care: United Kingdom

When the National Health Service (NHS) was founded in 1948, the consultants–medical and surgical specialists–could only be persuaded to come on board by giving them contracts which allowed them to pursue private practice outside the time they devoted to their NHS work. Nye Bevan, the health minister at the time, was accused of " stuffing their mouths with gold, " and many felt the NHS practice would be given lower priority, but the compromise worked and most consultants who have undertaken private practice over the years have also regularly worked more than their contracted hours for the NHS. The NHS enabled all the people of the country to receive health care for free at the point of need, as it still does to a large extent (prescription charges for drugs being one exception), but some have always wanted additional access to private health care and have been prepared to 'top up' by buying private medical insurance or by paying for private health care directly. Most straightforward private medicine is undertaken in small independent hospitals, but more complex treatment may be undertaken in NHS hospitals, with patients being accommodated in private or pay bed wards. In many ways the NHS has been very successful; for people who suffer trauma or acute illness the service is excellent, and the primary care system has been second-to-none. However, those with chronic conditions and those needing routine elective surgery have had a less good service which, for the latter, has often meant long waits. Many have argued that health care in the UK has been rationed by waiting; for example, not so long ago many patients could have waited over a year for total hip replacement. Indeed, up to quite recently, the principal reason given for buying private medical insurance (PMI) was to avoid waiting but, despite this issue, PMI uptake in the UK has been running at a fairly stable 12-13% for the last 10 years–partly because it is expensive. In July 2000, the Labour Government adopted a new strategy for the NHS, the NHS Plan.* Reduction of waiting times became a key priority and, for the first time since the formation of the NHS, ministers decided that the NHS could contract with independent hospitals to use their spare capacity and reduce waiting lists. This was also a tactic, akin to throwing a grenade in a pool, to stir up NHS hospitals and persuade …