Thread by @RoyMotteram

I had an interesting conversation yesterday with a group of #Tory voters about the #NHS.

The consensus was that "we can't afford to keep pouring money into the NHS. It's inefficient, & needs a good manager to wade in & sort it out."

A 🧵 1/11

They went on to discuss nurses (mixed reviews between very caring, & spending their shift at the nurses' station huddled around a computer, rather than being on the ward), & the difficulty of getting a face-to-face meeting with a GP.
2/11

They also compared the NHS with healthcare in France, where apparently there is a similar shortage in GPs, but no problem in arranging an appointment.

The general view was that healthcare in France is superior to that in the UK.
3/11

I pointed out that I believed that healthcare spend per head was greater in France & Germany than the UK, but I didn't have the numbers to hand.

This didn't appear to register with any of them, or dent their assertion that we couldn't "pour more money" into the NHS.
4/11

There seemed to be a general acceptance that we need to move to an insurance based model, as in the USA, but that seems to me to be an unconscious shift of the question from "how much do we spend on healthcare?" to "how do we fund healthcare spend?"
5/11

So, today I spent a little time looking at healthcare spend as a % of GDP, & per head.

Which was interesting.

You can see that USA stands out at 18.8% of GDP, with UK on 12%, below France on 12.2% & Germany on 12.8%
6/11

If you look at those figures on a "per head" basis, the figures for the UK are less favourable (presumably due to lower GDP per head).

USA is still out there in the lead (more on that later), but from these figures, France spends 15% more per head than the UK, & Germany 42%
7/11

So are those USA figures a reflection of better healthcare in the US? Not necessarily.
We know about medical costs leading to bankruptcy, but led by another anecdote, I looked at the cost of a broken leg around the world.
USA: £25550, UK:£3363, France:£3086, Germany:£5465
8/11

My guess is that US healthcare costs don't reflect a higher quality of care, but are inflated by the insurance model used for funding. There are layers of middlemen, each taking their cut, & an environment where cost savings are not considered important.
9/11

Bottom line: we could increase NHS spend by 6%, and we'd still be spending less as a %age of GDP than Germany, but we can't aspire to the same level as care as you get in France or Germany until the GDP per capita in the UK is improved.
10/11

And if anyone tries to tell you that we should shift to an insurance based funding model, point to those broken leg costs. Changing the way healthcare is funded clearly does not reduce healthcare costs - in the case of the USA, it clearly multiplies them by a factor of over 5
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