Sir, - I have had an opportunity to read the recently-launched Labour Party discussion document, "Curing Our Ills". I've discussed the document with some of my Irish colleagues. In addition, I presented some of the ideas to my graduate class in health economics at Syracuse University, and was able to discuss some of the proposals in that document with my students, who come from many countries, in Europe and Asia. In my view, "Curing Our Ills" is an extraordinarily far-seeing document.
There are two currents in healthcare reform in Europe and North America. One group of reformers seeks to address inequality of access to healthcare and seeks a level playing field, removing artificial distinctions based on income or social class. Another group of advocates seeks more allocational efficiency in the delivery of medical care, and uses decentralisation and market solutions, or market logic, as the principal device for achieving it. This document focuses on the former set of goals, but manages also to address and achieve the latter as well. It is a 21st century document.
It has three blockbuster ideas, together with some other important innovations. 1. Universal health insurance: the change, introduced for powerful equity reasons, has the by-product that it will introduce competition into the financing of the public health services. To the extent that competition provides benefits to buyers, those benefits will now extend to the lower income groups who are currently financed by direct state means. That is a change which is very much in harmony with recent thinking and innovations in both Europe and North America. There are similar changes, which bring market decision-making techniques, elsewhere in the discussion document. The document treats this as the centrepiece. However, the other two ideas are also extremely important.
2. Universal free GP service: again, this is a proposal motivated by equity which can have important efficiency rewards as well, by removing distinctions in general practitioner care.
3. Budget-responsible autonomous Hospitals: the system proposed would subject every secondary care provider to efficiency standards for their responsiveness to the needs of patients, for their innovativeness, and for their cost consciousness.
There are a great many subtle and difficult questions raised by this proposed scheme. This is not a criticism. The proposal is fundamental and important. A major reason for a discussion document is to work out all the important implications of proposals such as the present one. There are a variety of ways in which this new scheme can be articulated, which can preserve the powerful central idea, while at the same time addressing other important values. I commend the document to the attention of your readers. - Yours,
A. Dale Tussing, Professor of Economics, Syracuse University, Syracuse, New York, 13244.