U.K. Leader Pushes Sweeping Changes To Health Care

Britain's Prime Minister David Cameron has proposed some of the most sweeping changes to the country's National Health Service in its history. The government says the changes are designed to give doctors more say in running the NHS, and patients more freedom of choice. But critics point out that NHS doctors will be allowed to take more private patients, and some hospitals will be allowed to opt out of the NHS entirely — raising the possibility that U.S. HMOs might come in to fill the vacuum.

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Britain's Prime Minister David Cameron has promised that his country's National Health Service will be exempt from the sweeping cuts he's making in the government budget. But he has proposed the most profound changes to the system in its 62-year history. Supporters say opening the NHS to market forces will save money and give doctors and patients more choice. Critics fear the five-year plan amounts to the dismantling of socialized medicine.

Vicki Barker reports from London.

VICKI BARKER: Britain's new conservative-led government took office this spring with a crowd-pleasing pledge to purge the bean counters and the paper pushers from the NHS. Andrew Lansley is Britain's health minister.

Mr. ANDREW LANSLEY (Health Minister, Great Britain): The dismantling of this bureaucracy will help the NHS realize up to 20 billion pound of efficiency savings by 2014, all of which will be reinvested into patient care.

BARKER: By 2014, the current government-funded management structure is to be dissolved, throwing as many as 30,000 administrators out of work. Eighty percent of the NHS budget will be turned over to doctors for them to spend as they see fit. Some of it will likely be spent on outsourcing clerical functions physicians can't or won't do, says Chris Ham. He's with the public health think-tank the King's Fund. Ham applauds the broad outline of the restructuring, but fears the devil is in the details.

Professor CHRIS HAM (Chief Executive, King's Fund): This is the biggest organizational upheaval in the health service probably since its inception. This will be quite destabilizing for two or three years.

BARKER: The British medical journal agrees. And a recent editorial argued that past reorganizations proved expensive failures. But others worry success could prove expensive, too. The number of private patients that doctors and hospitals can have will no longer be limited and both doctors and patients will have wider choice of health care providers.

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BARKER: That could mean NHS practices will compete for patients with private insurance companies like the British health care giant Bupa.

Dr. Kambiz Boomla works in the deprived East End of London. He worries that Britain will end up with what supporters of universal health care fear most a two-tiered system like America's, he says.

Dr. KAMBIZ BOOMLA (Clinical Lead, Clinical Effectiveness Group): I think all markets in health care result in inequity with people who live in the better off parts of the country being able to purchase more health care than people who live in the poorer areas. So I don't think markets in health have any place at all.

BARKER: The former labor health minister Andy Burnham charges the government's real agenda is to break up the NHS. Why, he asks, is Britain's health service being thrown open to market forces in the depths of a recession?

Mr. ANDY BURNHAM (Former Labor Health Minister): This reorganization is the last thing the NHS needs right now. It needs stability, not upheaval. All of its energy must be focused on the financial challenge ahead.

BARKER: But if socialized medicine is under threat here, it's not clear how hard Burnham's fellow Brits will fight to defend it. A recent poll showed that most of the working class and middle class voters who deserted the Labour Party in the last election did so because they've become increasingly skeptical about the role of the state.

Already, the U.S. private health giants Humana, Aetna and United Health are looking to expand their operations in the U.K., now that they're no longer facing government-subsidized competition.

For NPR News, I'm Vicki Barker in London.

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