Awareness of health as a social value, and not only as a state of individual well-being, an increase in health care costs, the introduction of new medical technologies, inflation, and the decline in public health due to socio-demographic, environmental and other factors necessitate health care reform. Two main directions should be distinguished characterizing the general trends of health care reforms occurring all over the world, regardless of the level of health of the population and the state of health care (Johnstone, 2016). One should be the formation of a market system of public health and privatization. Second should be the state regulation of market relations and centralized planning, Insurance medicine plays an intermediate role in a certain sense, as it provides social guarantees for obtaining NHS for a wide range of people, especially the poor, in conditions of partial or complete privatization of health care.
In modern conditions, the creation of national public health systems is connected with the desire to provide equal opportunities for rendering NHS to all levels of society, with the priority of preventive health care, and due to the constant rise in the cost of NHS in conditions of privatized health care. At the same time, in UK there is a reverse process of the privatization of NHS, which is mainly due to the lack of sufficient funds for priority financing of public health, the need to raise funds from the population and employers, and the desire to create a system of interest in health protection, workers, and the population (Haldenby, 2016).
The main argument for the privatization of health care is the thesis that only the market can be the only effective means of accumulating and redistributing resources in health care. It is assumed that all citizens are sane, and health care is an individual responsibility, that market competition stimulates spending cuts in conditions of limited resources, that in the market conditions, excessive use of NHS are prevented, personal responsibility for health increases, the burden of the state’s spending on NHS is most reduced (Appleby, 2011).
Reducing the government’s spending on health is achieved through decentralization of administrative and financial control of institutions providing medical assistance, delegating part of its responsibility for public health, and pursuing a tax policy that primarily stimulates the development of the private sector in medicine. The purpose of this tactic is to transform the government from a provider of NHS into a source of creating favourable conditions for the provision of such assistance. At the same time, as a result of this approach, a large number of people may be denied access to any kind of medical assistance at all, and in the system of treatment and prophylactic provision of the rest of the population, a situation is inevitable in which NHS directly depends on the income level of the population (Johnstone, 2016).
Among the arguments against privatization, there is an unhealthy competition between forms of NHS, since profit-oriented services remove “cream”, refusing to assist to low-income patients, chronic patients and the elderly. Conflict of interests in the marketplace reduces the quality of NHS, “corrodes” the patient’s confidence in his doctor and society in medicine as such. In addition to social and ethical, there are also economic objections to the privatization of the NHS system. In particular, the free market is by nature an opponent, not an ally of the policy of restraining price increases: an increase in the number of expensive medical services, methods and means of treatment is welcomed, and the population is forced to consume medical services in volumes far exceeding the real need (HSPM (n.d). In view of the above arguments, large-scale privatization of medical aid appears to be an action that is economically unconvincing, politically unjustified, morally flawed and introduces social tension into society.
Health insurance is also not without its shortcomings, since until recently, the usual practice was to increase insurance premiums as health care costs increased. At the same time, payments for health insurance decreased. Thus, the burden of health financing was shifted to those who can pay, and the entire national health system was doomed to self-financing.
The best system for organizing health care is the NHS system based on health insurance. The NHS perfectly combines the elements of profit-oriented medicine, with equal access to high-quality medical services for residents of the country, which ensures high health indicators of the population. The UK health care model is based on a nationwide insurance program on the principle of pre-financing and represents the right to full NHS to every citizen regardless of his financial situation, place of residence, age and occupation (NHS (2016).
The flexible combination of centralized and territorial health financing in UK stimulates local initiatives and at the same time allows the federal government to implement a nationwide health policy. In general, the role of the regulatory principle in the health management system is growing. The licensing procedure for creating new hospitals has been introduced. The same procedure applies to major investment projects – the modernization of hospitals, the acquisition of particularly expensive types of equipment. Restrictions have been placed on the expansion of the hospital bed, quotas have been set for the training of new doctors, and at the federal level, and local governments are limited (Nuffield Trust 2016).
NHS was created taking into account the experience of different experiences around the world, which, unfortunately, is known only to those who studied it and knows the history of its creation. The experience of organizing the UK public health system also shows its high efficiency and availability with relatively low NHS costs (NHS (2016).
The fundamental piece of the assets is framed in the focal spending plan and is circulated starting from the top to the administration vertical. Brought together financing permits to limit the development of the cost of treatment. This issue was substantially less intense for Great Britain than for nations with financing frameworks (Davis, Stemikis, Squires & Schoen, 2014). Current government changes in the UK utilize two fundamental components to enhance the viability of openly subsidized human services: to start with, the expansion in rivalry among doctor’s facilities and other specialist co-ops; furthermore, new authoritative measures went for expanding the level of neighbourhood self-governance and autonomy of administration inside the national wellbeing framework. In modern conditions, a completely privatized health care system is impossible in any country in the world, so the central issue is the choice of a balance between public and private medicine within a unitary health system.
The analysis shows that the most economical form of health care organization providing a sufficiently high level of NHS is the public health system. State health care, in comparison with the private one, has great opportunities for intensive contacts with the general population and for providing the necessary NHS, preventive work. The main forms of public health financing, typical of United Kingdom, are general taxation and compulsory insurance. Trends in the development of health care in the country should be taken into account in the context of health care reforms implemented in United Kingdom. The “key” to health care reform lies in a reasonable combination of market relations and state regulation. Achieving these goals is most likely in a unitary health care system with a relatively small sector of private medical practice, based on health insurance, whose structure and organization will only complement the public health system. Many functions of health management can be successfully implemented at the level of local executive bodies. Naturally, healthcare reforms should cover all aspects of the health care organization: financing, training of medical personnel and primary health care and management of scientific research.
Appleby, J. (Appleby, 2011). What’s happening to NHS spending across the UK? BMJ. https://doi.org/10.1136/bmj.d2982
Davis, K., Stemikis, K., Squires, D. & Schoen, C. (2014) Mirror, mirror on the wall: how the performance of the U.S. health care system compares internationally. Available at: http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf (Accessed 22 January 2018).
Haldenby, A. (2016). Delivering the 2015 spending review objective of successful NHS partnerships with the private sector. Reform. Available at: http://www.reform.uk/wp-content/uploads/2016/07/Delivering-the-2015-Spending-Review-objective-of-successful-NHS-partnerships-with-the-private-sector.pdf (Accessed 22 January 2018).
HSPM (n.d) European Observatory: The Health Systems and Policy Monitor. Available at: http://www.hspm.org/searchandcompare.aspx (Accessed 22 January 2018).
Johnstone, I. (2016). ‘Creeping privatisation of healthcare is damaging the NHS, study finds’. Independent, 28th July. Available at: http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-health-service-healthcare-privatisation-a7160771.html (Accessed 22 January 2018).
NHS (2016) NHS England: Health and high-quality care for all, now and for future generations. Available at: https://www.england.nhs.uk/ (Accessed 22 January 2018).
Nuffield Trust (2016) Nuffield Trust: Evidence for better health care. Available at: http://www.nuffieldtrust.org.uk/ (Accessed 22 January 2018).
Pollock, A. (2014). The privatisation of the NHS. Available at: https://www.youtube.com/watch?v=Cz5dl9fhj7o (Accessed 22 January 2018).