The National Health Service (NHS)
The National Health Service (NHS) was established primarily to provide “a comprehensive, integrated service free at the point of use” (Martin, Beech, MacIntosh, and Bushfield 2015). The system aimed to provide universal healthcare coverage to all in times of health care need (Oliver 2005, p.15). Despite comparing fairly across global healthcare systems and topping the list of the leading healthcare systems worldwide according to the latest report by the Commonwealth Fund (Wishart 2016), the free medical care system faces serious challenges in meeting its core objectives. This state of affairs has led to concerns whether the government should continue to give free medical care to all. This paper presents a critical evaluation of arguments in favour of and against the universal healthcare system.
Arguments in favor of the Universal Healthcare System
Equal Access to Healthcare and Improved Public Health
Proponents of the system of a free health care system argue that the system enhances equal access to healthcare and improves public health. Universal healthcare coverage is consistent with “the principle of equal access for equal need” (Oliver 76). The NHS caters for all individuals, including those who are uninsured, underinsured and those who cannot afford healthcare the services they want (Moreno-Serra and Smith 2012). This argument is predicated on the idea that no human, irrespective of his or her status in the society, should be denied access to adequate healthcare (Reddy et al. 2011). They emphasize that “progress towards universal health coverage on the grounds that it leads to improvements in population health” (Moreno-Serra and Smith 2012, p.918). The NHS eliminates barriers related to social demographics including income, race, age, and gender (Oliver 2005). By increasing medical coverage to all, the universal health care promotes fairness and equality (Burki 2018).
Improving Healthcare Equality
Furthermore, the free medical care system is a potential strategy for improving healthcare equality. In an ideal universal healthcare system, all people - rich and poor – have equal access to basic medical services such as prescription medication, seeing a doctor, and ambulance call-outs, among others. It is imperative to note that several groups in the UK earn below-average incomes, including “the long-term unemployed, the disabled, the elderly, families with children, and some ethnic minority groups” (Marmot 2015). Programmes such as Sure Start allow households with young children to get off to a good start in life. The elderly have unique health problems due to old age. They are more likely to suffer accidents that take longer to heal, heart disease, cancer, and other major causes of ill health (Marmot 2015). By implementing such programmes, the NHS fosters equality and fairness in healthcare access and delivery.
Well-Run System
Moreover, a universal health care system is well-run (Reddy et al.). A universal healthcare system, particularly a single-payer healthcare system, is a single public agency that assumes the responsibility of providing medical coverage to all eligible residents. The result is a strong, efficient, and well-run system with a streamlined system for financing health services that ensure that all eligible citizens have an opportunity to access health care, essential medicines, and technologies, a sufficient capacity of well-trained, motivated health workers without having to worry about financial hardship. Most importantly, the NHS is an autonomous organization that is effectively coordinated, highly accountable, develops appropriately trained healthcare providers, and focused on fostering the implementation of evidence-based high-quality health-care practices (Reddy et al. 2011). The NHS is more affordable compared to private healthcare. Private firms have the discretion in determining what to charge insurance premiums, medical tests, and service, a factor that allows them to make a profit (Oliver 2005). On the contrary, the government is more interested in promoting the best interest of its citizens rather than making profits.
Decreasing the Costs of Medical Coverage
Additionally, the universal health care system can decrease the costs for medical coverage in several ways. First, it can ensure well-coordinated and centralized governance, improve monitoring for health care costs, and reduce potential wasteful spending by lower administrative costs and cost control (Reddy et al. 2011). These factors make NHS efficient, affordable, and attractive. By 2017, the NHS had 1.7 million staff from all over the world with 29% and 15% of their doctors and nurses having been trained outside the country, respectively (Burki 2018, p.15). Efficient and good governance of NHS explain the following findings. First, the UK tops Commonwealth Fund’s list of top eleven developed countries with the best healthcare systems (Wishart 2016). Second, “Britons are the least likely to face catastrophic health costs or to skip medical consultations because of the expense” (Burki 2018, p.15).
Arguments against the Universal Healthcare System
Costliness
However, the free medical care system has been said to be costly. As depicted in Appendix 1, the UK is currently spending heavily on health care. In 2015 alone, the UK spent $145 billion on health care and health budget and costs projected to surge by $5.7 billion and 38 billion in 2020, respectively (Appleby 2016). Kitwood (2017) reported that the NHS is confronted by growing financial and operational pressures and at imminent risk of collapse. Although the quality of care has maintained and improved, Oliver (2005) points out that the NHS is said to be under serious strain. Some overt symptoms of this strain include “patients left on trolleys in hospital corridors, operations canceled, staff under pressure, and deficits on the rise” (Oliver 2005, p.16). Long wait time for certain medical services, a sharp increase in drug costs, substantial cuts in social care funding, shortage of staff (e.g. general practitioners and nurses), and restriction on pay rises are other chronic problems the free medical care system breeds (Burki 2018, p.16). The growing prevalence of chronic diseases such as cancer and diabetes and cardiovascular conditions exert more pressure on an already overstretched health care system (Martin et al. 2015). The NHS has also been said to be wasteful since patients may seek care for even minor illnesses like coughs due to free medical care. Altogether, these issues justify the claim that the NHS is costly.
Reference
ListAppleby, J., 2016. Is the UK spending more than we thought on health care (and much less on social care)? The KingsFund. Available athttps://www.kingsfund.org.uk/blog/2016/06/uk-spending-health-care-and-social-care
Burki, T., 2018. From health service to national identity: the NHS at 70. The Lancet, 392(10141), pp.15-17.
Kitwood, D., 2017. The NHS vs global healthcare systems. The Guardina. Available at https://www.theweek.co.uk/nhs/87658/the-nhs-vs-global-healthcare-systems
Marmot, M., 2015. The health gap: the challenge of an unequal world. The Lancet, 386(10011), pp.2442-2444.
Martin, G., Beech, N., MacIntosh, R. and Bushfield, S., 2015. Potential challenges facing distributed leadership in health care: evidence from the UK National Health Service. Sociology of health & illness, 37(1), pp.14-29.
Moreno-Serra, R. and Smith, P.C., 2012. Does progress towards universal health coverage improve population health?. The Lancet, 380(9845), pp.917-923.
Oliver, A., 2005. The English National Health Service: 1979‐2005. Health economics, 14(S1), pp.S75-S99.
Reddy, K.S., Patel, V., Jha, P., Paul, V.K., Kumar, A.S., Dandona, L. and Lancet India Group for Universal Healthcare, 2011. Towards achievement of universal health care in India by 2020: a call to action. The Lancet, 377(9767), pp.760-768.
Wishart, E., 2016. Which country has the world's best healthcare system? The Guardian. Available at https://www.theguardian.com/society/2016/feb/09/which-country-has-worlds-best-healthcare-system-this-is-the-nhs
Appendix
Appendix 1: Changes in Healthcare Spending in the UK
Source (Appleby 2016).
