Written by Andy Smith, MTM publisher


Quite a few countries claim that tag, in fact probably most of the western nations might do so. So clearly they cannot all be right, and most likely all but one is wrong.

What is certain, as recent polls in Canada have highlighted, is that healthcare is far and away the biggest area of concern for voters. The same can be said of the UK and the US. As a result those elected to office all have a view colored by the lens of their political biases.

In the US this ranges from the extremes of left and right and from ‘free healthcare for all’ to the ‘free market system is the only system’. In the UK any debate is impossible as the healthcare unions (whose interest really is the patient!) and the left treat any debate as a threat to the ‘system’. That the system was set up in 1952 and urgently needs scrutiny would ensure the immediate labeling of anyone suggesting such a thought as a fascist etc. etc.

However, irrespective of your country, we all know that politicians are quick to promise the ridiculous and slow to deliver on common sense.

Most European countries, including my own UK, would class the US Healthcare system as anything from inhumane to massively expensive and operating a two-tier system where the poor and weak lose out. Canadians might well say the same and probably do, but they are quick to cross the border for treatment when they want or need (and can afford) it and not when their own system can eventually provide it, if it does.

There is the difficulty; in many government administered systems treatment may not be available, where you live, or when you feel you need it or, depending on what treatment is required, may not be available at all. (I am not talking about elective treatments bafflingly favoured by increasing numbers of young women but things like cataracts and hernias).

In many cases there are not enough hospital beds or the region has run out of budget.

In a privately run system anything is possible, though bankruptcy might be your end point. Or if you have no money then with luck something may be available at some stage. If you can afford it you will be encouraged to visit other specialists, some of the time with reason, and you may well undergo entirely unnecessary, expensive treatment on the basis of ‘prevention’. However, within five miles of where I sit, two new hospitals are being built and aside from access to my own doctor, I could walk into 4 or 5 well equipped urgent care centers, not to mention my local pharmacy that is now offering broader healthcare services.

New hospitals in the UK are rarer than hens’ teeth.  A recent party promise to build six new ones (for a population of 60m plus) had to be abandoned immediately because the budget wasn’t available. Anyone who can afford it in the UK avails themselves of private insurance and most can.  It is unlike the US where many cannot afford the over priced and over complex monopoly insurance offers with very high patient payment. However, as heart disease and cancer have been given national priority status, free care in the UK for these two conditions very possibly matches ‘bankrupting’ levels of care in the US.

So where does this leave healthcare education? Despite the massive resources available to governments and their ability to access population data and model the future they have, in many cases, failed to make appropriate provision, or as mentioned above, cannot alter their systems to take account of demographics, new treatments, new drugs and new medical conditions.

As a result, while the US appears to be building healthcare facilities at a massive rate, there are not enough medical schools and not enough residency places for the ones that exist. I.e. there is enough money in healthcare but not enough in education. A shortage of nurses already exists, and too little too late is being done.

The UK recently launched six new medical schools, with modern curricula, but cannot find the money to build new hospitals.

Healthcare education and training professionals across the developed world seem to be accessing the latest technologies as they become available but are struggling to adapt their pedagogy to the new, more applied, realistic methods of instruction. Some educators of course resist these changes and an even higher percentage of hospital based physicians will insist that the old ways are best and that through their career education and training is adequate. 

As to the wider question of what is the best healthcare system, there are many answers but clearly ‘all government’ or ‘all the market’ do not suffice. The two will have to live together, but both will have to be operate significantly more efficiently than they do now.