on life support

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The NHS has never been more in the spotlight than of late. And it’s completely understandable, essential perhaps, that in a situation where tens of thousands of people have died that we compare and contrast different countries’ approach to the Covid-19 pandemic. Our oft-pronounced belief is that the National Health Service is truly world-leading and the envy of all but does this stack-up in reality? The European Union’s most populous and most-similarly developed country, Germany, seems to provide the most natural, logical comparison.

Comparing the performance of health systems is a zero-sum game at best, a notoriously fraught business much dependent upon what measures and statistics you choose in the first place, followed by the ranking emphasis you then place upon them. When cost-effectiveness, ease of access and fairness of service are the key criteria, the NHS scores well. Yet pick other factors and we fail to break into the top-ten. Ditto Germany’s, whose strengths include shorter waiting times – where over 80% get an appointment with their chosen GP on their day of choice, specialist service access and noticeably higher serious-illness survival rates. Where the UK has 28 doctors per 10,000 inhabitants, Germany boasts 42; it has three times as many hospital beds and over four times as many intensive care beds.

Unlike the taxation-funded NHS, the single most distinguishing feature of Germany’s health service is that it is based on statutory (legally binding) health insurance, SHI as it is termed internationally. Every employed adult earning less than the euro equivalent of £56,000 has to fork-out a smidgen over 7% of their salary towards this insurance, a sum then equally matched by their employer. The insurance is provided by more than a hundred not-for-profit independent funds, Krankenkassen, which all cover the costs of a high basic healthcare provision. Earning above this level allows the individual the option of taking out private insurance, but coverage via SHI remains close to 90% of the population.

Most notably wrt the coronavirus crisis, Germany’s health service implemented a nation-wide testing and tracking system in early March, months ahead of the majority of its counterparts and continues to outperform in this regard, by a factor of four. Many cite the country’s 400 separate authorities across sixteen regions, free from central control, as the reason for this success. Each region is responsible for the specifics of insurance coverage and results in a highly flexible system better attuned to respond to any crisis. Mind, they too had a drastic shortage of relevant PPE and their health minister, Jens Spahn, has come under just as much media flack as our very own Matt Hancock.

Ultimately, of course, the choice and development of any system comes down to an economic cost: Germans spend £3,744 per head of population on their SHI system whereas we shell-out only £3,126 for the NHS; Germany chips-in over 11% of its GDP for its healthcare where we spend just 7.5%. As with many aspects of life and society, with national healthcare systems you get what exactly what you pay for. Recent events need to fuel the mature and non-partisan conversation concerning how the NHS develops, what services it should encompass and provide and how these need to be funded.