Werkstuk: Second World War
Introduction:
Due to the baby boom after the Second World War and the success of birth control, our country will have more and more old people after the year 2000. Japan and all the countries around us will also have to deal with the same problems as Holland: The ageing. Often people think negative about the future, because old people will live longer and they will be a burden to our society. But you can think different too. F.i. The study of old people, gerontology, can tell us a lot about how sickness and defects can develop when we get older. Scientists will also find out more about the way of live and medicine research and medical technology will focus more on the quality of treatment. Individuality is nowadays normal; "the old men" don't exists. This has social consequences not only for the health service, but also for the labour and income policy. In spite of the individual wishes, the needs or wages, people are forced to stop working on the same age, or even better much earlier.
The dismissal of the elderly from the production process wrongly suggests that the elderly can't keep up with the rest, physically and mentally. This is not the only prejudice. It is thought that there are much more elderly people than there are in real. In fact the increase of senior citizens between 1960 and 1985 is 3%, but between 1985 and 2000 this will only be 2.5%. Another prejudice is that people think that a huge part of the elderly is infirm and therefore expensive. But only 10 % of the present senior citizens live in a residential home for the elderly. Of course the government has to take her policy into account due to the changements of the structure of the population. But one thing, we need to be very careful that the elderly people will not see themselves as a big problem, because if they do, the problem will only grow bigger.
History of the health care in the Netherlands:
In the period after the Second World War the sector of health care grew a lot. Especially after the sixties and seventies the growth was really big; the period 1964-1974 showed an average cost increase of about 18% a year. This brought the government to the point where they tried to get a grip onto the sector. Ever since the Structurenota Health Care of 1974 there has been a conduct carried of cost-control and planning. As conduct instruments the government handled for instance in building freezes for hospitals and in bedreductions. Besides there were some attempts to control the tariffs, there was made a system of budgetfinancing for hospitals and reduced in labour costs. This conduct was a success in one way, because the costs of the health care sector in percentage of the national income decreased in the eighties from 9,8% to 9,4%. But on the other hand the burocration increased and the legislation became continually more voluminous and more complexed. On top of that there came some main sticking points as waitinglists and a shortage in workforce into existence. The existing conduct of planning, controlling and the increasing of government's influence seemed to have reached the borders.
The second cabinet Lubbers laid the future of the health care in the hands of an advisecommission, which became known as commission Dekker. This commission chose in her report "Willing to change" (1987) for another form of governmentconduct. The approach of the commission put the notion substitution central. This meant that where possible a more expensive form of care should be replaced by a cheap one: professional care for at home, treatment because of prevention and admission for daytreatment. To get this, the commission wanted that competition and costknowledge would play a bigger roll. The commission has the opinion that the introduction of a basic-insurance for the total population is needed.
In this basic-insurance is about 85% of the present package of health care and social services are taken in account. Things like hospitals, familycare and GP's. All the people insured pay a contribution, which is procentual for the biggest part and for the smaller nominal (which is a fixed amount per insured). For the resting 15% people can take a complementary insurance; the contribution for the complementary insurance is totally nominal. The commission-Dekker thinks that the introduction of this basic-insurance will cause for competition in the health care sector. Competition will, in the first place, exist between the insurance companies. These are the health insurance funds and the private health insurance companies, who will both, act as the executor of basic-insurance and complementary insurance. The insurance companies are rivals of each other at the consumers-market. The consumer himself gets the choice at which insurance company he wants to be insured. Because of this competition, the insurance companies are forced to stipulate the conditions as cheap as possible by the "offeres" of care (hospitals and doctors). So in the second place there will be a competition between the offerres as well. This is because the insurance companies in the future, different than it is the case with the National Health Service now, will not be obliged to every offerer of health care to make a deal. The too expensive hospitals or specialist will not be in favour in the market.
According to the commission, the knowledge of cost of the consumers should increase. For that the already existing own amount should be raised and new ones should be introduced. On top of that the nominal contributions are going to differ per insurance company. The consumer is therefore stimulated to choose the cheapest working insurance company.
To finish, the commission pleats for a cogent deregulation:
" The present legislation knows a complex structure with an increasing amount of rules which are continuously getting more detailed of nature. Similar rules don't only occur in government, but they also occur in deals between parties, whether or not appointed by government. (?)
This leads to negotiation of many parties, but none of the participants can take an ultimate decision and each participant can indeed frustrate the decision of the other. This structure provokes inefficient handling, doesn't advance that the right treatment is given at the right place and blocks the substitution."
The second and third cabinet-Lubbers adopted a large part of the proposition of commission Dekker. This could be concluded from for instance the note "Working on a Care-renewal" (plan Simons) of the third cabinet-Lubbers. A couple of provisions (like medicine) were siphoned to the AWBZ (in England the CSDPA, Chronically Sick and Disabled Persons Act), which should function as predecessor of the new basic insurance. The introduction of the plan Simons however stagnated in the course of the cabinetsperiod.
The cabinet-Kok did not follow the ideas of Dekker and Simons. In the coalition agreement, the cabinet is searching for an alignment with the proposition from the report "Shared care: Better care" of the commission Biesheuvel (1994). This commission is the one who proposed that financial means for the medical specialists and the hospital would be taken into one budget. According to the coalition agreement the National Health Service insurance and the private insurance kept on existing next to each other. They both had to grow toward each other qua contributionlevy. There should also be introduced a for everyone obliged uniform insurance package with an own risk of FL 200,-. Some of the earlier underclassed provisions in the CSDPA will go back to the National Health Service insurance and the Private insurance.
The government says that the Health Care sector may grow with at least 1.3% each year, but on the other hand the big price-increasements in this sector have to end. There will be an active antitrustpolicy pursued. In a comment it is doubted if this governmentpolicy for the health care sector can be controlled enough.
Medicine use in the Netherlands:
Elderly people use a lot of medicine. Therefore they are an important target group for industry and medicine research. Much of the knowledge we have nowadays about medicine is because of the experiments done with young voluntaries (most of them are males) and the results of grown up patients not older than 65 years.
Unfortunately, medicine has a lot of side effects and often it is a heavy burden to the excretory organs like the liver and the kidneys. When you are old your organs do not work well anymore, so old people usually have problems with these organs if they use too much medicine. Especially old women of the extreme old age group often use different medicine for a very long period. Since we still don't know all the effects of different medicine on each other, they run a risk. Scientists once hoped that with very simple tests the excrete ability of the liver and the kidneys could be estimated for a certain age group, so that they could treat the individual with an adjusted amount of medicine without measuring. This never succeeded, because when you get older, the differences between individuals increase. Another problem is the ability to react on the treatment. This means how sick you are, the resilience of the consequences of the disease and the horrible side effects of the treatment. A part of the old age caused defects, are almost impossible to treat with medicine anymore.
In the fifties the treatments of high blood pressure with medicine were only applied if there was damage at the organs, because nasty side effects appear. The present treatment has less side effects, which causes the prescription of medicine much quicker, but even now the discussion for the norms of this treatment is pursued. On one hand a permanent high blood pressure can cause veincalcination or a stroke, but on the other hand it is possible that because of the use of too drastically working blood pressure lowering medicine, damage of veins can appear. Sometimes the cause of high blood pressure is bad working kidneys. This is one of the problems the elderly people who have used too much medicine have.
Too much medicine causes bad kidneys, causes bad excrete, causes high blood pressure, causes veincalcination or a stroke, causes hospitalisation, causes nursing, get more medicine prescribed meaning more costs.
The application of medicine for the elderly means that the individual gets treat by a medicine that is often used in combination with other medicine. Therefore the prediction to the success of the treatment becomes difficult. Often the patient trivialises the symptoms or blames it to his age, so that side effects often stays out of the visual field of the doctor and therefore is harder to recognise.
Many elderly people often have more than one disease at the same time and are treated by different doctors. These doctors often take no account of each other and don't even know what medicine the other prescribed. This can lead to big problems for the patient. The GP tries to regulate some of the medicine and the patient doesn't understand why he gets another medicine instead of the one prescribed. This is often difficult to explain to the elderly people. Most of the patients don't want another medicine and they bring the old label of their medicine to the pharmacy. Sometimes they use these medicine for many years and they use too much or too less of it.
The British National Health Service (NHS):
The British National Health Service was set up in 1948 and was designed to provide equal basic health care, free of charge, for everybody in the country. Before this time, health care had to be purchased by consumers in a market place, supplied by individual doctors. Consumers requiring medical advise and attention could buy a quantity of health care from their local doctor as seemed appropriate according to their needs and, not least, their capacity to pay. Thus the level of a person who is unwell is the determinant of whether health is provided. Nowadays the government is directly responsible for the National Health Care system, except for a small minority who wishes to continue to purchase health care as private patients. So in effect, most doctors like nurses, ancillary staff, became government-paid employees. Hospitals were now government owned and operated and available to all as referred by their doctor or GP (General Practitioner). The NHS has over 480,00 people in their medical staff, making it the biggest employer in Europe, although Britain actually spends less per person on health care than most of her European neighbours.
The founders of the NHS seemed to believe that the need for health care was both finite and quantifiable. Given an initial appropriate provision of resources then it was hoped that the burden on the state of ending the financial worries of those who became ill would in due course diminish. In practise since 1948 expenditure on the health care has been far from finite. No developed country is able to spend as much on those of its citizens who are sick as would be necessary to take full advantage of improving health care technology. Thus it has not been possible in the past half-century to eliminate unmet health needs. Indeed much discussion of health care during this whole period has been characterised by references to "a crises in the NHS". The rationing of scarce resources has been the reality, thus providing endless tension between those seeking treatment on the one hand and the medical care and ancillary professions within the NHS on the other. There has been much parliamentary and political debate caused by this inability to meet the aims of those who founded the NHS of ensuring that sufficient resources were provided, to meet all genuine cases of need for health care.
Of course somebody needed to pay for this. So they started to let the English people pay for it by general taxation, which takes up about 83% of the costs. The rest is met from the National Insurance contributions paid by those in work There are charges for prescription and dental care but many people, such as children, pregnant women, old aged people (older than 65 years) and those on Income Support, are exempt from payment. Most people are registered with a local doctor (a GP) who is increasingly likely to be a part of a health centre, which serves the community. We know now that the population of Britain gets older and this causes that the hospital service now treats more patients than ever before, although patients spend less time in hospital. The National Health Service hospitals, from which many were built in the nineteenth century, provide nearly half a million beds. During the 1980s there was a considerable restructuring of Health Service with an increased emphasis on managerial efficiency and the privatisation of some services (for cleaning etc). At the end of the 1980s the government introduced proposals for further reform of the NHS, including allowing some hospitals to be self-governing and encouraging GPs to compete for patients. This would mean that the patients would be able to choose and change their family doctor more easily and GPs would have more financial responsibility. The political questions continue of how much money should be provided to support the NS and where it should come from.
British health care: Demand and supply:
This picture figure illustrates the problem that emerged with the provision of health care by the NHS. In the figure the demand for health care, D1, is downward sloping but the supply of health care resources is shown as a vertical straight line SQs. It is shown like this to highlight that at any given moment of time the supply of health care is fixed. It reflects the amount of resources made available by the government in the light of its philosophy and other competing claims on tax revenue. If the NHS supplies health care at a zero price, then the quantity demanded Qd exceeds Qs by the distance Qd - Qs. Unless the government is able to provide additional resources of the amount Qd - Qs then this quantity of health care is not available to those who seek it. It represents a number of patients unable to receive treatment. Were the market to be allowed to clear at the market-clearing price P, then the situation of an excess demand at the zero price (because health care is free of charge) would not exist. For those unable to receive medical treatment, because of the excess demand, their only option, other than paying for private provision, is to wait the time necessary until state provision becomes available. They join a waitinglist and hope that in the fullness of time, which may be a year or more, it is their turn to receive treatment. There is, of course, the possibility that the lifes of some of those awaiting treatment are meanwhile at risk. Their need for an operation in hospital is recognised but can't be met. What this figure shows is a situation of scarce health care resources being rationed queuing rather than by price.
Interview:
Date:
29-05-1999
What's your name?
My name is Elaine Guicherit
I heared that there are some problems in your country. Could you please tell me something about it?
The Surinam guilder doesn't keep its value anymore, because of the high value of the Dollar and the Dutch Guilder. The prices are high, well actually prohibitive and many people can't buy the stuff they need to stay alive. While almost three-quarter of the population is really poor, the government keeps spending money on 'not needed' things. There were rels and the chambers were fired by Mr. Weidenbosch, who is the president of Surinam. But that's not enough. We want him to give up his presidentship.
Why do you want that to happen?
Simply because he is a liar and a thief.
All with all, it's not really good arranged in Surinam. How about the healthfacilities?
It's really bad. People pay the health insurance fund from their loanwages, even though they actually know that they can't get their money back when they need it, but their faith in it never disappaered. The government uses this money that it gets from the National Health Service for other purposes. Because the medical doctors actually work and don't get their wages, they are striking for, let's say, almost a year now and they demand higher amounts for their treatments.
This means that there are probably long waiting lists. Is this true?
Yes. The waiting lists are very long and because the people can't afford to pay for the treatments, the lists only grow bigger.
If you, for instance, need to go to hospital, is there any kind of insurance besides the National Health Service to pay for this?
No, we have only got the National Health Service and they don't pay the doctors and the pharmacists.
So this means that you have to pay for the treatments yourself?
Yes, that's true. So, actually we pay twice. One time for the National Health Service and the other time for the treatment itself, which is abolutely absurd..
Does the government really don't even pay a nickel?
No, not even one nickel, because they have already spend everything on bridges and paying their ambts. Actually, the government is short of money and to solve that problem, they "steal" money from every fund, also from the pensionfund and the retirement pension fund. The government will soon be, or is already, totally faillet.
Is it the same with eveybody or are there some sorts of groups of people who do get paid something when they 're ill?
No, it is not the same for everybody. People who work for the government get everything for free: trips, voyages, health care and they have a high salary. But on the other hand, the 'normal' people need to pay everything themselves. When you get into the emergency room you need to pay SF 5.000,00 otherwise they don't help you, unless you are bleeding to death.
How about the old people in Surinam?
The have the most problems to live. They only get SF 30.000,00 retirement money from the retirement fund every month, but many times the government doesn't have the money to pay them. If you don't have a pension going with the retirement fund money, you really have a problem to buy things like food, medical care and clothes. The living standard is
SF 200.000,00, so you can imagine how poor some old people are.
Thank you for this interview.
Conclusion:
Lately the governments through Western Europe have faced a growing problem of financing the burden of welfare spending. A theme apparent in policies to tackle this problem is both the role of competition and the use of price incentives. These two related concepts aim to curb cost enhance efficiency of health care provision. However, the resource to market systems such as the international market model in the United Kingdom, will not solve the phenomenon we recognised at the outset of this paper -the inexorable long-term growth in demand for health care, based on technical changes and rising expectations of longer life expectancy. Even in the United States, where spending on health care as a proportion of GNP (Gross National Product) exceeds, that in any other country there is much dissatisfaction with the delivery of health care and the inequality in its provision. Indeed there is little evidence to suggest that the average person's state of health in the United States is significantly enhanced by the higher level of health spending compared with elsewhere.
Bibliography:
D.L Knook, A. Brouwer and many others
Ouderdom
Roosendaal
Drukkerij van Poll
1986
K. ten Bruggencate
Wolters' handwoordenboek Nederlands - Engels
Den Haag
1994
Brittain explored
Marieke van Wamel en Esther Verhoef
Gids Patiënteninformatie 1998
Utrecht
1998
Consumentenbond
Verzekeringsgids
Utrecht
Kosmos-Z&K Uitgevers
1996
Hans Buunk
De economie in Nederland
Groningen
Wolters-Noordhoff
1996
H. hansma and many others
De nieuwe W.P. medische encyclopedie
Amsterdam
Uitgeversmaatschappij Elsevier
1965
H.R. Hoetink and many others
De grote Winkler Prins encyclopedieën, De Nieuwe W.P., deel 5 SCHL - ZIJZW
Den Haag
Uitgeversmaatschappij Elsevier
1968
Internet:
http://www.minvws.nl
Quotation:
From the book: "De economie in Nederland"
Page 143
Lines 2 to 10
Due to the baby boom after the Second World War and the success of birth control, our country will have more and more old people after the year 2000. Japan and all the countries around us will also have to deal with the same problems as Holland: The ageing. Often people think negative about the future, because old people will live longer and they will be a burden to our society. But you can think different too. F.i. The study of old people, gerontology, can tell us a lot about how sickness and defects can develop when we get older. Scientists will also find out more about the way of live and medicine research and medical technology will focus more on the quality of treatment. Individuality is nowadays normal; "the old men" don't exists. This has social consequences not only for the health service, but also for the labour and income policy. In spite of the individual wishes, the needs or wages, people are forced to stop working on the same age, or even better much earlier.
The dismissal of the elderly from the production process wrongly suggests that the elderly can't keep up with the rest, physically and mentally. This is not the only prejudice. It is thought that there are much more elderly people than there are in real. In fact the increase of senior citizens between 1960 and 1985 is 3%, but between 1985 and 2000 this will only be 2.5%. Another prejudice is that people think that a huge part of the elderly is infirm and therefore expensive. But only 10 % of the present senior citizens live in a residential home for the elderly. Of course the government has to take her policy into account due to the changements of the structure of the population. But one thing, we need to be very careful that the elderly people will not see themselves as a big problem, because if they do, the problem will only grow bigger.
History of the health care in the Netherlands:
In the period after the Second World War the sector of health care grew a lot. Especially after the sixties and seventies the growth was really big; the period 1964-1974 showed an average cost increase of about 18% a year. This brought the government to the point where they tried to get a grip onto the sector. Ever since the Structurenota Health Care of 1974 there has been a conduct carried of cost-control and planning. As conduct instruments the government handled for instance in building freezes for hospitals and in bedreductions. Besides there were some attempts to control the tariffs, there was made a system of budgetfinancing for hospitals and reduced in labour costs. This conduct was a success in one way, because the costs of the health care sector in percentage of the national income decreased in the eighties from 9,8% to 9,4%. But on the other hand the burocration increased and the legislation became continually more voluminous and more complexed. On top of that there came some main sticking points as waitinglists and a shortage in workforce into existence. The existing conduct of planning, controlling and the increasing of government's influence seemed to have reached the borders.
The second cabinet Lubbers laid the future of the health care in the hands of an advisecommission, which became known as commission Dekker. This commission chose in her report "Willing to change" (1987) for another form of governmentconduct. The approach of the commission put the notion substitution central. This meant that where possible a more expensive form of care should be replaced by a cheap one: professional care for at home, treatment because of prevention and admission for daytreatment. To get this, the commission wanted that competition and costknowledge would play a bigger roll. The commission has the opinion that the introduction of a basic-insurance for the total population is needed.
In this basic-insurance is about 85% of the present package of health care and social services are taken in account. Things like hospitals, familycare and GP's. All the people insured pay a contribution, which is procentual for the biggest part and for the smaller nominal (which is a fixed amount per insured). For the resting 15% people can take a complementary insurance; the contribution for the complementary insurance is totally nominal. The commission-Dekker thinks that the introduction of this basic-insurance will cause for competition in the health care sector. Competition will, in the first place, exist between the insurance companies. These are the health insurance funds and the private health insurance companies, who will both, act as the executor of basic-insurance and complementary insurance. The insurance companies are rivals of each other at the consumers-market. The consumer himself gets the choice at which insurance company he wants to be insured. Because of this competition, the insurance companies are forced to stipulate the conditions as cheap as possible by the "offeres" of care (hospitals and doctors). So in the second place there will be a competition between the offerres as well. This is because the insurance companies in the future, different than it is the case with the National Health Service now, will not be obliged to every offerer of health care to make a deal. The too expensive hospitals or specialist will not be in favour in the market.
According to the commission, the knowledge of cost of the consumers should increase. For that the already existing own amount should be raised and new ones should be introduced. On top of that the nominal contributions are going to differ per insurance company. The consumer is therefore stimulated to choose the cheapest working insurance company.
To finish, the commission pleats for a cogent deregulation:
" The present legislation knows a complex structure with an increasing amount of rules which are continuously getting more detailed of nature. Similar rules don't only occur in government, but they also occur in deals between parties, whether or not appointed by government. (?)
This leads to negotiation of many parties, but none of the participants can take an ultimate decision and each participant can indeed frustrate the decision of the other. This structure provokes inefficient handling, doesn't advance that the right treatment is given at the right place and blocks the substitution."
The second and third cabinet-Lubbers adopted a large part of the proposition of commission Dekker. This could be concluded from for instance the note "Working on a Care-renewal" (plan Simons) of the third cabinet-Lubbers. A couple of provisions (like medicine) were siphoned to the AWBZ (in England the CSDPA, Chronically Sick and Disabled Persons Act), which should function as predecessor of the new basic insurance. The introduction of the plan Simons however stagnated in the course of the cabinetsperiod.
The cabinet-Kok did not follow the ideas of Dekker and Simons. In the coalition agreement, the cabinet is searching for an alignment with the proposition from the report "Shared care: Better care" of the commission Biesheuvel (1994). This commission is the one who proposed that financial means for the medical specialists and the hospital would be taken into one budget. According to the coalition agreement the National Health Service insurance and the private insurance kept on existing next to each other. They both had to grow toward each other qua contributionlevy. There should also be introduced a for everyone obliged uniform insurance package with an own risk of FL 200,-. Some of the earlier underclassed provisions in the CSDPA will go back to the National Health Service insurance and the Private insurance.
The government says that the Health Care sector may grow with at least 1.3% each year, but on the other hand the big price-increasements in this sector have to end. There will be an active antitrustpolicy pursued. In a comment it is doubted if this governmentpolicy for the health care sector can be controlled enough.
Medicine use in the Netherlands:
Elderly people use a lot of medicine. Therefore they are an important target group for industry and medicine research. Much of the knowledge we have nowadays about medicine is because of the experiments done with young voluntaries (most of them are males) and the results of grown up patients not older than 65 years.
Unfortunately, medicine has a lot of side effects and often it is a heavy burden to the excretory organs like the liver and the kidneys. When you are old your organs do not work well anymore, so old people usually have problems with these organs if they use too much medicine. Especially old women of the extreme old age group often use different medicine for a very long period. Since we still don't know all the effects of different medicine on each other, they run a risk. Scientists once hoped that with very simple tests the excrete ability of the liver and the kidneys could be estimated for a certain age group, so that they could treat the individual with an adjusted amount of medicine without measuring. This never succeeded, because when you get older, the differences between individuals increase. Another problem is the ability to react on the treatment. This means how sick you are, the resilience of the consequences of the disease and the horrible side effects of the treatment. A part of the old age caused defects, are almost impossible to treat with medicine anymore.
In the fifties the treatments of high blood pressure with medicine were only applied if there was damage at the organs, because nasty side effects appear. The present treatment has less side effects, which causes the prescription of medicine much quicker, but even now the discussion for the norms of this treatment is pursued. On one hand a permanent high blood pressure can cause veincalcination or a stroke, but on the other hand it is possible that because of the use of too drastically working blood pressure lowering medicine, damage of veins can appear. Sometimes the cause of high blood pressure is bad working kidneys. This is one of the problems the elderly people who have used too much medicine have.
Too much medicine causes bad kidneys, causes bad excrete, causes high blood pressure, causes veincalcination or a stroke, causes hospitalisation, causes nursing, get more medicine prescribed meaning more costs.
The application of medicine for the elderly means that the individual gets treat by a medicine that is often used in combination with other medicine. Therefore the prediction to the success of the treatment becomes difficult. Often the patient trivialises the symptoms or blames it to his age, so that side effects often stays out of the visual field of the doctor and therefore is harder to recognise.
Many elderly people often have more than one disease at the same time and are treated by different doctors. These doctors often take no account of each other and don't even know what medicine the other prescribed. This can lead to big problems for the patient. The GP tries to regulate some of the medicine and the patient doesn't understand why he gets another medicine instead of the one prescribed. This is often difficult to explain to the elderly people. Most of the patients don't want another medicine and they bring the old label of their medicine to the pharmacy. Sometimes they use these medicine for many years and they use too much or too less of it.
The British National Health Service (NHS):
The British National Health Service was set up in 1948 and was designed to provide equal basic health care, free of charge, for everybody in the country. Before this time, health care had to be purchased by consumers in a market place, supplied by individual doctors. Consumers requiring medical advise and attention could buy a quantity of health care from their local doctor as seemed appropriate according to their needs and, not least, their capacity to pay. Thus the level of a person who is unwell is the determinant of whether health is provided. Nowadays the government is directly responsible for the National Health Care system, except for a small minority who wishes to continue to purchase health care as private patients. So in effect, most doctors like nurses, ancillary staff, became government-paid employees. Hospitals were now government owned and operated and available to all as referred by their doctor or GP (General Practitioner). The NHS has over 480,00 people in their medical staff, making it the biggest employer in Europe, although Britain actually spends less per person on health care than most of her European neighbours.
The founders of the NHS seemed to believe that the need for health care was both finite and quantifiable. Given an initial appropriate provision of resources then it was hoped that the burden on the state of ending the financial worries of those who became ill would in due course diminish. In practise since 1948 expenditure on the health care has been far from finite. No developed country is able to spend as much on those of its citizens who are sick as would be necessary to take full advantage of improving health care technology. Thus it has not been possible in the past half-century to eliminate unmet health needs. Indeed much discussion of health care during this whole period has been characterised by references to "a crises in the NHS". The rationing of scarce resources has been the reality, thus providing endless tension between those seeking treatment on the one hand and the medical care and ancillary professions within the NHS on the other. There has been much parliamentary and political debate caused by this inability to meet the aims of those who founded the NHS of ensuring that sufficient resources were provided, to meet all genuine cases of need for health care.
Of course somebody needed to pay for this. So they started to let the English people pay for it by general taxation, which takes up about 83% of the costs. The rest is met from the National Insurance contributions paid by those in work There are charges for prescription and dental care but many people, such as children, pregnant women, old aged people (older than 65 years) and those on Income Support, are exempt from payment. Most people are registered with a local doctor (a GP) who is increasingly likely to be a part of a health centre, which serves the community. We know now that the population of Britain gets older and this causes that the hospital service now treats more patients than ever before, although patients spend less time in hospital. The National Health Service hospitals, from which many were built in the nineteenth century, provide nearly half a million beds. During the 1980s there was a considerable restructuring of Health Service with an increased emphasis on managerial efficiency and the privatisation of some services (for cleaning etc). At the end of the 1980s the government introduced proposals for further reform of the NHS, including allowing some hospitals to be self-governing and encouraging GPs to compete for patients. This would mean that the patients would be able to choose and change their family doctor more easily and GPs would have more financial responsibility. The political questions continue of how much money should be provided to support the NS and where it should come from.
British health care: Demand and supply:
This picture figure illustrates the problem that emerged with the provision of health care by the NHS. In the figure the demand for health care, D1, is downward sloping but the supply of health care resources is shown as a vertical straight line SQs. It is shown like this to highlight that at any given moment of time the supply of health care is fixed. It reflects the amount of resources made available by the government in the light of its philosophy and other competing claims on tax revenue. If the NHS supplies health care at a zero price, then the quantity demanded Qd exceeds Qs by the distance Qd - Qs. Unless the government is able to provide additional resources of the amount Qd - Qs then this quantity of health care is not available to those who seek it. It represents a number of patients unable to receive treatment. Were the market to be allowed to clear at the market-clearing price P, then the situation of an excess demand at the zero price (because health care is free of charge) would not exist. For those unable to receive medical treatment, because of the excess demand, their only option, other than paying for private provision, is to wait the time necessary until state provision becomes available. They join a waitinglist and hope that in the fullness of time, which may be a year or more, it is their turn to receive treatment. There is, of course, the possibility that the lifes of some of those awaiting treatment are meanwhile at risk. Their need for an operation in hospital is recognised but can't be met. What this figure shows is a situation of scarce health care resources being rationed queuing rather than by price.
Interview:
Date:
29-05-1999
What's your name?
My name is Elaine Guicherit
I heared that there are some problems in your country. Could you please tell me something about it?
The Surinam guilder doesn't keep its value anymore, because of the high value of the Dollar and the Dutch Guilder. The prices are high, well actually prohibitive and many people can't buy the stuff they need to stay alive. While almost three-quarter of the population is really poor, the government keeps spending money on 'not needed' things. There were rels and the chambers were fired by Mr. Weidenbosch, who is the president of Surinam. But that's not enough. We want him to give up his presidentship.
Why do you want that to happen?
Simply because he is a liar and a thief.
All with all, it's not really good arranged in Surinam. How about the healthfacilities?
It's really bad. People pay the health insurance fund from their loanwages, even though they actually know that they can't get their money back when they need it, but their faith in it never disappaered. The government uses this money that it gets from the National Health Service for other purposes. Because the medical doctors actually work and don't get their wages, they are striking for, let's say, almost a year now and they demand higher amounts for their treatments.
This means that there are probably long waiting lists. Is this true?
Yes. The waiting lists are very long and because the people can't afford to pay for the treatments, the lists only grow bigger.
If you, for instance, need to go to hospital, is there any kind of insurance besides the National Health Service to pay for this?
No, we have only got the National Health Service and they don't pay the doctors and the pharmacists.
So this means that you have to pay for the treatments yourself?
Yes, that's true. So, actually we pay twice. One time for the National Health Service and the other time for the treatment itself, which is abolutely absurd..
Does the government really don't even pay a nickel?
No, not even one nickel, because they have already spend everything on bridges and paying their ambts. Actually, the government is short of money and to solve that problem, they "steal" money from every fund, also from the pensionfund and the retirement pension fund. The government will soon be, or is already, totally faillet.
Is it the same with eveybody or are there some sorts of groups of people who do get paid something when they 're ill?
No, it is not the same for everybody. People who work for the government get everything for free: trips, voyages, health care and they have a high salary. But on the other hand, the 'normal' people need to pay everything themselves. When you get into the emergency room you need to pay SF 5.000,00 otherwise they don't help you, unless you are bleeding to death.
How about the old people in Surinam?
The have the most problems to live. They only get SF 30.000,00 retirement money from the retirement fund every month, but many times the government doesn't have the money to pay them. If you don't have a pension going with the retirement fund money, you really have a problem to buy things like food, medical care and clothes. The living standard is
SF 200.000,00, so you can imagine how poor some old people are.
Thank you for this interview.
Conclusion:
Lately the governments through Western Europe have faced a growing problem of financing the burden of welfare spending. A theme apparent in policies to tackle this problem is both the role of competition and the use of price incentives. These two related concepts aim to curb cost enhance efficiency of health care provision. However, the resource to market systems such as the international market model in the United Kingdom, will not solve the phenomenon we recognised at the outset of this paper -the inexorable long-term growth in demand for health care, based on technical changes and rising expectations of longer life expectancy. Even in the United States, where spending on health care as a proportion of GNP (Gross National Product) exceeds, that in any other country there is much dissatisfaction with the delivery of health care and the inequality in its provision. Indeed there is little evidence to suggest that the average person's state of health in the United States is significantly enhanced by the higher level of health spending compared with elsewhere.
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Internet:
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Quotation:
From the book: "De economie in Nederland"
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