Predicting the behaviour of individuals in times of ill-health can be tricky - I have no specific data on this matter, but I can call upon a wealth of personal experience which tells me that there is no such thing as odd behaviour when it come to ill-health: I have met a man in his 40s who spent three months lying in bed, unable to get up, before he sought medical help, and I have met a young woman who insisted on doing her own rectal exam in A and E, so that I wouldn’t have to. There is nowt as queer as folk.
What however is clear is that health care is important to people. Wealthy countries around the world spend billions on their health care. Per person, the expenditure on health care in the USA is two and a half times the European average, and yet 50 million Americans still have no health care cover, and the cost of medical treatment is the biggest single cause of bankruptcy. Overall the level of expenditure means that a lot of wealthy Americans are probably spending a lot of money on health care cover that they do not need.
We live in a country where the concept of not being able to access medical care, and spending all of our money on medical bills is unthinkable. We live in a country which spends less money per capita that any other major Western country, but still achieves similar health outcomes. The NHS is one of the most efficient health care systems in world, because of its economies of scale, and because of its lower administration costs: in countries where there are competing health care providers and insurers, they must each duplicate the administrative set-up themselves, rather than having the one set-up we have.
The price we pay for the kind of access that we have is that the people who contribute the most money to the NHS pot, are the people who tend to use it the least: there is a clear correlation between health and affluence. The way we fund our health service is a value judgement that we as a country made in 1946, and one to which many still adhere. But not everyone agrees.
If you are having trouble imagining how the NHS will change after the Health Bill, think about how you access dental care today. The concept of NHS dental care is often illusory, and where it does exist the level of care can be two tiered. I think dentistry serves as a really useful microcosm of how the NHS could change.
Given wider availability of private services, and lengthening waiting times for NHS services, an increasing number of people will take out private health cover, and no doubt businesses will increasingly offer health cover as an employment perk. Hospitals will compete for the higher tariffs they can charge to private patients, enticing them with better hotel services, fast access, preferential scheduling and a more personalised service. The NHS patients will wait longer, in poorer accommodation, and experience cancellations more frequently. As the level of service and experience (if not necessarily quality) plummets, more people will find the money to go private, perhaps risking bankruptcy (remember how much we value good health care). There will be an increasing clammer from those with health cover for tax rebates to reimburse them for the contributions they make to the NHS, and so the spiral starts.
Of course, I may be wrong, and the Health Bill may transform the quality and level of medical care in the NHS, but my mind cannot reach such lofty imaginative heights at the moment.