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Health Bill could bring in US-style system, report warns

The Health Bill could usher in a US-style healthcare financing model, and the erosion of entitlements to free care, a paper published by the British Medical Journal warns today.

The analysis, Legal basis for providing fewer health services to fewer people in Health and Social Care Bill, tackles the key legal reforms in the bill, which is currently in the House of Lords.

Professor Allyson Pollock and David Price, both from Queen Mary, University of London, conclude that the legislation provides a legal basis for imposing new charges, and for providing fewer health services to fewer people in England.

The study says: “Taken together, the measures would facilitate the transition from tax-financed health care to the mixed financing model of the USA.”

The authors say the bill’s transfer of powers from the secretary of state to clinical commissioning groups would abolish the current duty on primary care trusts to secure health services for everyone living in a defined geographical area.

As a result CCGs would be able to provide fewer taxpayer-funded health services. CCGs will also have the power to decide what services are “appropriate as part of the health service” and to delegate the decision to commercial companies.

The paper argues: “Where a CCG or its commercial company decides that services are no longer appropriate as part of the government-funded health service they may fall out of the health service altogether and be charged for.”

Under the bill, public health functions, such as vaccination, screening services and promotion of healthy lifestyles, would also be delegated to local authorities and may be chargeable.

The authors say ministers have failed to explain which services must be provided free at the point of use and which may become chargeable.

“Legal analysis shows that the bill would allow reductions in government-funded health services as a consequence of decisions made independently of the secretary of state by a range of bodies,” they conclude. “The bill also fails to make clear who is ultimately responsible for people’s health services and it creates new powers for charging.”

They add: “The reform signals the basis for a shift from a mainly tax-financed health service to one in which patients may have to pay for services currently free at point of delivery.

“The government has been unable to show, as it has argued, that these changes are ‘vital’. It does not have a mandate for this radical alteration of health care financing and it has avoided informed debate of the principle.”

Readers' comments (5)

  • Another quality and weighty review of the changes spelling out the risks we all know are there.

    Another quality and weighty review that La-La and his mate Dave can at best ignore and at worst claim is simply wrong where the authors don't understand the changes being made.

    It's all too sad really.

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  • Unbelievable given the plans were not in either party manifesto and directly contradict the coalition agreement.

    Seems we are more a malevolent dictatorship in 4 year bursts than a parliamentary democracy.

    Could never vote Conservative or Liberal again after this debacle.

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  • matt_black

    So an author who believes that anything done in the private sector (not just in health) publishes an analysis based on the assumption that any health reform is evil and comes to the conclusion that the bill is all about driving us to the american system.

    Which part of this is news?

    The conclusion of the paper only makes sense if we impute machiavelian motivation to the entire government and assume that nothing good can come from the changes. I'd prefer to assume that many aspects of reform are good ideas but the bill has been a catastrophe in detail and implementation.

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  • There's no need to assume malevolent intent, Stephen, when you can always rely on good old unintended consequences.

    Forget the detail: this bill lacks direction, leaving us with little but soothing soundbites like "giving control to clinicians" and "reducing bureaucracy".

    It's not enough. Oh,and there's no electoral mandate for it, because it's quite the opposite of what was in the manifesto.

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  • Stephen Black writes:

    "The conclusion of the paper only makes sense if we impute machiavelian motivation to the entire government and assume that nothing good can come from the changes".

    Sounds about right to me

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