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To be American or not to be...

14th May 2006

What seems to be slowly emerging from the latest financial crisis in the health service is a gradual rise in volume from those people advocating more radical reforms. It is gradually dawning on many people that the current NHS model is unsustainable and needs to be changed to something quite different. This is unlikely to be an overnight revelation; the publicly funded NHS we have now is the darling of the British public and any attempt to radically change it - or even hint at such a thing - is surely a vote killer at any election. So the voices advocating change are still quiet at the moment.

But what model should we turn to? There are plenty to choose from across the world but all have their own problems. And this is where it gets interesting. There are, not surprisingly, those who think a gradual migration to the US insurance model is inevitable; after all, we do everything American-style eventually. They may have better health care but they also pay twice as much for it.

But two studies published in the last week must give pause for thought.

The revelation that white, middle-class Americans are twice as sick as their British counterparts is quite startling. I expect to see more analysis of this over the coming weeks but it is not altogether fair to directly link this with the US healthcare model as it is mainly due to lifestyle factors. However, a second study showing that US infant mortality rates are similar to Latvia and among the lowest in the developed nations is more of a concern. Described as "outrageous" by an American colleague, both findings are certainly causing a stir across the pond. We're going to follow these studies closely because we could all learn a lot; perhaps an endless debate about what healthcare model we should adopt is actually missing the entire point...

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