In a letter to this week´s BMJ, a researcher expresses his concern on how in order to empower NHS patients with choice, the UK government is in danger of sacrificing the principle of equality on which the service was founded.
His observations come up at the same time as the Obama administration declared that US healthcare reform is “on track” and would protect the right of patients to choose their doctor.
Adam Ali, a Frank Knox Fellow at Harvard University, writes that the US healthcare system is driven by the desire for choice whereas the NHS is driven by the desire for equality. “But, if choice is possible then, by definition, differences exist in the quality of care being provided in the NHS”, he writes. He continues by saying that some individuals are receiving a substandard service that an informed patient would not choose.
He argues that by permitting patient to choose, inequality will increase since some patients can make more knowledgeable choices than other, in other words wealthy and well educated people. These individuals are more likely to be politically active. As a result, he adds: “promoting choice seems an effective way of scoring political points in the guise of making the NHS fairer”.
He says in conclusion: “The fairest approach is to foster a system in which choice is not needed, by improving those services which no informed patient would choose”.
“Choice and equality in health”
Adam M Ali, Frank Knox fellow
BMJ 2009; 338:b2423
bmj
Written by Stephanie Brunner (B.A.)