HFMA VIEWS

Mark Knight
Chief Executive, HFMA-U.K.

Whilst in L.A. recently, I watched SiCKO, and I can see why it is going to be a big challenge for your industry.

I don’t know if you’ve caught up with it, but it really compares the Canadian, U.K., French, and Cuban systems to your own. The U.K. experience was quite accurate, with a trip to the Hammersmith Hospital, amongst other things. Whilst Tony Benn is a little on the left, his observation that there would be a revolution if our health service wasn’t funded the way it is was pretty accurate. As our Chairman said at the ANI in his speech: Universal free care is an accepted right of the British people.

The bit where the doctor from the U.K. talks about getting paid more if people get better is called the Quality and Outcomes Framework (QOF). HFMA-U.K. has a joint committee with NHS Employers that advises on the financial aspects of this framework. This is not quite as rosy as Moore portrays, and of course he doesn’t talk about waiting--which is a maximum of four hours in the emergency room and 18 weeks from referral to treatment. Having said that, when I came back from the ANI, my community physician referred me for an X-ray, which I had at the local hospital: I walked in and waited about 10 minutes, with no charge, of course. The X-ray was e-mailed to a consultant radiologist and the results produced a day or two later--still no charge!

Another issue that Moore didn’t mention was taxation. Our higher-rate tax is 40 percent, and we have a national sales tax (Value Added Tax, or VAT) at 17.5 percent covering most items, apart from items like children’s clothes. The lower rate is 23 percent, but those on that rate also pay national insurance at 10 percent--a tax developed specifically to fund the health service. Oh, and don’t forget gasoline at $9 a gallon, with the U.K. virtually self-sufficient in North Sea Oil as well. This is in addition to significant taxation on a number of different areas. The French system is, I understand, even more taxed; however, whilst it remains a sensitive issue in the U.K., there is a general acceptance of this level of taxation (but not of the taxman himself, of course!).

The part where in France, the government does your laundry can also happen in the U.K. under the Sure Start Programme as with the Home Help Programme provided for older people by local authorities. I thought this was a bit misleading as I wouldn’t see it necessarily as a function of the health service; rather, it’s connected to the whole area of social services, so I am not sure how relevant it is here. The French example also didn’t cover the financing of the system, and our understanding is that the system is in major deficit. The Paris Exchange may allow us to ask that question to the head of the French Hospitals Association.

My conclusion about SiCKO is that Moore is trying to impose a European ideal on the U.S., which isn’t necessarily going to work. The way we in Europe (and Canada) think about society is arguably different to the U.S.A. Your stress is on the rights and freedoms of the individual, rather than in Europe, where the sense is that government needs to help people in a more direct way. There is a parallel with handguns here. I understand the U.S. citizen has at the heart of the Constitution the right to bear arms. In Europe, societies have collectively agreed that for the greater good of the whole community, individuals do not have a right to bear arms. Their rights are therefore subordinate to the whole community. 

I am sorry to say that I felt just a little smug with all the gasps around the movie theatre. This was particularly the case as I waited later that day for my return flight, returning to my healthcare system with all of its benefits. It will be interesting to see whether Moore manages to have any effect at all on the healthcare industry, because you aren’t going to go down our route anytime soon, it seems to me.