Exclusive NHS bosses need to be ‘careful what they wish for’ when seeking inspiration from the market-driven American health system, the RCGP chair has warned, after a US fact-finding mission.
In her first interview since returning from a week-long tour of public, private and free medical clinics in Chicago Dr Clare Gerada, RCGP chair and a GP in Kennington, told Pulse she had seen a two-tier market that produced ‘immense’ health inequalities and often ‘demoralised’ doctors.
She claimed the trip showed the US’s ‘chaotic system of mainly multinationals’ often pressurised doctors into restricting, rather than provide care. She also said the system created a gulf in patient care and often damaged choice and access, as insurance companies limited care options.
Dr Gerada said: ‘A lot of policymakers, think-tanks and NHS managers have been to the States and come back raving about managed care and HMOs.’
‘From what I saw of managed care, at the very good end it is just about OK, but for the most part I wouldn’t want the NHS to go down that route. I went thinking that HMOs were this promising integrated model, but from my experience they seemed more about creating networks where you limit choice and work on demand reduction.’
‘People will accuse me of being ideological but the whole reason I made this trip was to see the US system firsthand. What I learned was to celebrate the NHS – nobody is saying it is perfect but governments reforming it need to be careful what they wish for.’
Dr Gerada, who self-funded the American trip, said she was confident NHS policymakers would not fully adopt the US model. However, she warned that the appetite of successive governments for market-driven NHS reforms will result in major inequalities in care.
‘We can have competition and choice in the NHS but if it is about turning to the market to make things better I would challenge that, and there are many millions in the U.S. who would agree. The Americans do not have a health system. They have a chaotic group of organisations, mainly multinationals.’
However, she added that the work of free-clinics she visited highlighted the ‘fantastic work’ of US doctors, many of who gave up their time for free to treat uninsured patients.
‘We seem keen on importing this idea of choice and competition but from what I saw, US healthcare often doesn’t offer choice. If you are very wealthy you will have choice but I met doctors who said insurance companies suddenly pulled out of their hospitals and blocked patients from being treated there.’
‘The inequalities are immense. If you have the money you can have the best healthcare in the world, but I learned that almost two-thirds of all personal bankruptcies are due to health costs,’ she said.