As I write this, by coincidence, an announcement has been made about one of our Local Doctors’ Practices raising the fee for seeing a Doctor to £70. Nobody in Guernsey will be of the opinion that the costs of healthcare in the island is anything other than very expensive. That said, there are plenty of people who would spend £70 on a night out and not think twice about it (although you would get more than 10 mins for your money). But that probably indicates two things: the freedom to spend your money as you see fit – and you’re reliance upon the ‘State’ and belief in what you should be ‘entitled’ to (free or at minimum cost).
Don’t shoot the messenger, but this cannot continue
When we unpack that ‘entitlement’ we find that it is driven by several factors. More commonly, it is as a comparison with other places and the most likely are the UK and Jersey. That might be human nature, or it might be because we can access information about other places very easily, or it might be because we have come from one of those places and expect it to be so in Guernsey too. But the harsh reality is, as a subscale, Island economy, we cannot begin to provide the breadth of comparable services, or even at a comparable price when we do. All this of course is largely nullified since there is already a strong sense of entitlement in Islanders – largely reinforced over many years of provision free or at reasonable cost.
Don’t shoot the messenger, but this cannot continue. Nor should it come as a surprise, since for many years, various Assemblies have been warned of this and it is by no means a unique problem to Guernsey. The UK is a very good example of what the runaway costs of the NHS does to their economy – and what an ageing demographic forces upon the healthcare system. That is in a population of 65 million. We are a population of circa 65 thousand. It is illogical to assume that we can simply replicate what may be capable due to their economy of scale. But unfortunately, people do. So, for anybody thinking of standing for a Deputy seat, please understand that (maybe even more contentious than taxation), the future model of Healthcare and necessary changes to it – will meet with fierce resistance. Ironically, the solution to not having to take a very different approach to our current model – is to raise more revenue from taxation. But yet again, Islanders will not immediately make that direct connection.
We may have already got it wrong
Leaving aside the illogical approach to presuming we can replicate the Health systems of much larger jurisdictions, if you ask any Health Professional about what is the one thing we could all do to reduce the future costs of care, they will reply ‘invest in prevention’. By which, it is meant that we should all attempt to lead healthier lives (and from an early age), to reduce the complications that emerge in later life from not having done so. That doesn’t cover genetic conditions or accidents that might befall us along the way. But in reality, when the cost of sustaining Public Health has got to crisis proportions – then individuals taking on more responsibility for their dependence upon it does hold out some appeal..
This is quite logical – but if you cannot enforce it, then maybe other approaches are worth exploring. Our own model whereby a minor subsidy is paid to Primary Care Physicians who then have the freedom to charge beyond that – supplemented by a Secondary Care system that is largely free – is not sustainable any longer. Furthermore, the uneven use (and affordability) of insurance has certainly got a potential role to play in the overall mix. So what if we have got it wrong? What if perhaps we are looking at it from the wrong end of the telescope? Could the solution be reversing the subsidy funding?
So, Primary Care then would be very largely funded but Secondary Care (with some exceptions) would become the cost to be paid by the user – with assistance from Island-wide insurance? If you think about it, being cared for early enough to discover (for example) that following an annual, free health check that you may have early onset of whatever condition looks likely to materialise, will give most patients a better chance of overcoming or even surviving a deterioration otherwise. Further, Secondary Care is (or can be) very specific to the individual. So, whilst general Primary health is ‘universal’ – Secondary Healthcare is tailored to the individual. Some individual’s Secondary Healthcare is going to correspondingly cost more money than somebody in the next bed. It is very hard to make that ‘universal’ – and amazingly expensive too. Could this hold the clue to a different model of Universal Entitlement?
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