Health Issues of a Developed Country (The US)

Health Issues of a Developed Country (The US)

Since 1948 the NHS has undergone significant changes in its structure and mode of operation. There is a distinct shift as witnessed by a change from the fully public model of care delivery towards increasing private participation in the NHS system.

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The increasing health care consumption and cost pressures have, to an extent, compromised on the original 1948 manifesto of totally free health care access to all.

While the restructuring of the NHS listed in the white paper ‘Equity and Excellence: Liberating the NHS’ is in response to changing demands, care should be taken in the form of having enough performance monitoring and quality checkpoints that ensure that private participation does not erode some of the fundamental strengths and qualities of the NHS, the most basic of which is to enable equity of access to quality healthcare.

Introduction

The NHS was launched on July 5th 1948 by the then health secretary Mr. Aneurin Bevan with a view to provide healthcare for all based on citizenship and need and not based on the ability to pay. It was fully funded by taxation. The NHS therefore became the central umbrella organization that provided all medical and related services free at the point of access to all UK citizens (NHS, 2011). Since its inception the NHS has transformed significantly and today it has become the world’s largest publicly funded healthcare system (NHS, 2013).

The NHS employs more than 1.5 million people (White, 2010, pg 3). Though the original manifesto of the NHS was to provide quality medical care for all those in need irrespective of their ability to pay, the NHS has underwent a series of changes and reforms over the last several decades.

The aging society, increasing health care demands, and the financial pressures it creates on the healthcare system have in effect necessitated some significant reforms in the way the NHS operates.

This paper will discuss these changes in structure and functional aspects of the NHS as highlighted in the white paper ‘Equity and Excellence: Liberating the NHS’ (DH, 2010) and some fundamental reforms in context of the passing of the Health and social care bill 2011.

In the first 25 years from 1948 there was a clear distinction in that community health services were managed separately by the local authorities while hospitals were managed by the NHS.

Some structural changes in the NHS were bought about in 1974 and since then both community health services and hospitals have together come under the purview of the NHS (Webb, 2002, pg 4).

Under the original 1948 manifesto cost was not a factor and doctors were advised to provide the best care for the patient without any cost considerations (Leathard, 2000). Growing medical bills and budgetary deficits have constrained the government in fully implementing their primary manifesto of providing free treatment at the point of access, and gradually since 1951 charges were introduced for dentures and spectacles (Leathard, 2000, pg 34).

Similarly since 1952, prescription costs were introduced. Over the years prescription charges have witnessed an incremental increase and as of April 2012 prescription charges are at 7.65 (Politics .co.uk, 2012). Widespread protests against the prescription charges have contributed to several exceptions in the prescription drug charges including for children under 16, pregnant women, elderly people above 60, etc. More recently people with chronic conditions such as cancer have been included into those under the exempted category.

While in Wales and Northern Ireland prescription charges have been completely abolished, the English government has, however, indicated that no further free prescription programs would be introduced but that the new policies would focus on brining more fairness into the prescription charging system (Politics.co.uk, 2012).

Transition to a Market System

Chronic underfunding and gaps in services and the pressures to improve the overall operating efficiency have gradually led to the NHS from being a total public ownership entity towards a market based system. In fact this shift towards a market based system could be traced way back to the Thatcher administration that introduced the policies of ‘general management’ and ‘outsourc…………………………………………….