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Compulsory medical insurance the answer

Doctors should ask themselves whether they wish to continue as the patient's advocate and adviser or whether they wish to become agents of government.

After more than 50 years' experience of the NHS, it should be clear that government (of whatever political persuasion) seeks to obtain maximal medical services as cheaply as possible, and to that end seeks to control medical practice and its practitioners via rules, regulations and targets to an ever-increasing extent. The Carr-Hill formula is just a complex tool to secure this end.

I would suggest that, as in most Continental countries, doctors should be paid for what they actually do, and we should recognise this is unlikely to be achieved under the present funding arrangements. The logical way forward is to adopt a system of compulsory medical insurance, in which the state provides a variable portion of the insurance premium, depending on the individual's financial situation.

Dr CO Lister

Swindon, Wiltshire

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