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An Uber-Like Service Might Help Patients Escape Britain’s Socialist Health System

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Tags Bureaucracy and RegulationHealth

Last month marked the 70th anniversary of the creation of the National Health Service, Britain’s government-run monopoly healthcare provider. Since its creation, during the wave of nationalisations undertaken by the post-WWII Labour government of Clement Attlee, one of the most consistent themes in the history of the NHS has been its ongoing failure to keep pace with the healthcare systems of similarly developed countries. Indeed, the 70th birthday of the institution which has been called “the closest thing the English have to a religion” was marked by a string of articles in the mainstream press highlighting the shocking degree to which Britain’s socialist health system is failing to meet the needs of its patients.

There is certainly no shortage of headline-making statistics to fill such articles. Yet what is rarely explicitly pointed out is that many of the most shocking statistics are the direct result of one underlying factor: the long waiting times British patients have to endure before being treated. The true extent of the problem was highlighted by a recent Mises Wire article, which pointed out that 4 million people are currently languishing on NHS waiting lists (in a country of just 65 million), with as many as 33% of patients having to spend over four months on waiting lists before receiving surgery. With this in mind, it is little wonder that as many as 25% of British cardiac patients die while waiting for treatment, while around 20% of lung and colon cancer patients in the NHS have to wait so long for care that, by the time they finally start receiving treatment, their conditions have become incurable. All of this contributes to an average cancer survival rate of just 54.48% in the UK, compared with 71.18% in the United States.

One of the least reported, but most important components of the long overall waiting time experienced by British patients is the considerable wait required before even being allowed to see your local General Practitioner (G.P.). These non-specialised, neighbourhood doctors often form the first point of contact patients have with the NHS, when they first start noticing symptoms. The less time patients have to wait before seeing their local G.P., the better their chances of getting the specialist care they need before their conditions have progressed to a more dangerous stage. However, given that the NHS’s free-at-the-point-of-use structure necessitates rationing of scarce G.P. appointment time, this vital area is likewise afflicted by lengthy waiting lists, with patients having to wait an average of two weeks before even being allowed a first meeting with a doctor.

However, new technologies are increasingly enabling consumers to bypass these sorts of sluggish bureaucracies entirely; following the trail blazed by apps like Uber, which allowed people to avoid the quasi-governmental monopoly behind the taxi industry. One such example recently emerged in the form of a new app named "Qured," which aims to offer anyone in the Greater London area the ability to summon a doctor to their door within two hours. Rather than having to suffer through a two week wait before seeing an NHS doctor — free in terms of money but potentially costly in terms of patient discomfort and long-term recovery rates — users of Qured are able to arrange a consultation with a doctor or physiotherapist at a time and place of their own choosing, for a money payment of as little as £90. Having launched just last year, Qured already has over 30,000 downloads and 450 registered doctors.

In an important sense, this app — and the competitors which will doubtless follow — can be seen as a specific, real-world application of the economic principles which have so often led Austrians to advocate free market allocation of resources in general. Not only does it offer an alternative network through which patients can connect with doctors, outside of the sclerotic NHS bureaucracy which would typically perform that function for the vast majority of British G.P.s, but it is also able to cut waiting times by bringing G.P. consultations into the sphere of the monetary economy. Because the NHS does not charge patients for G.P. consultations, it is forced to grapple with the inherent scarcity of those appointments by other methods, leading it to ration appointments by lumping all patients into the same waiting list slow-lane. Now that this new technology is allowing patients the option to pay for a speedier service instead, patients will be able to demonstrate their preferences in a way that will allocate scarce doctors’ appointments to those who desire them most urgently.

In addition to this, the system of direct patient payments for G.P. appointments creates an incentive for healthcare providers to keep down costs and prices, to attract customers. The lack of this incentive in free-at-the-point-of-use systems is much of the reason for the soaring costs of healthcare in both Britain’s state healthcare system, and the heavily insurance-based system in the United States. It has for years been a common talking-point in debates over healthcare for free market advocates to contrast the falling price of, for example, Lasik eye surgery, which patients have to pay for directly, with the rising costs of other forms of healthcare paid for indirectly through insurance or government subsidy. By allowing British patients to pay directly for doctors’ appointments, we can expect to see this same incentive toward declining prices and rising quality to be introduced into Britain’s vital primary care system.

Although technology-based alternatives offer the potential for significant improvement in the quality of British healthcare, it is important to stress that a genuine free market in that sector is far from being achieved. A myriad of government restrictions and controls both restrict the supply and inflame the demand for healthcare services in a way that will continue to negatively impact the quality of British healthcare until far more fundamental reforms can be undertaken.

However, if the example of apps like Uber has shown anything, it is the potential for technological development to disrupt the old systems of government privilege and control in a way that sees consumers coming out as the ultimate beneficiary. If apps like Qured are able to have even a fraction of that impact on British healthcare, it could mark an important turning point in the fortunes of Britain’s perpetually crisis-beset healthcare sector.

George Pickering is a 2018 Mises Institute Research Fellow and a student of economic history at the London School of Economics.

Note: The views expressed on Mises.org are not necessarily those of the Mises Institute.
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