NHS myths

Public opinion about the public and private health sectors often uses a common separator between private hospitals and clinics and the NHS, i.e. the National Health Service. The difference between private and public, in common sense, is related to who provides the service, who gives the consultations, who performs the surgeries, treatments and diagnoses, etc.

Thus, from a political rather than economic perspective, the NHS should ideally be equipped with all the assets necessary to provide a full health service to all citizens. We have had an NHS for about 50 years, and we all want it, but the truth is that, in the search for efficiency, the private sector has always been an alternative service provider when the public sector is unable to respond.

The same is true in reverse: in many complex situations in which private payers are unable to provide a response, the public provider financed by the State provides a more comprehensive response. There is a tendency towards a balance, as the private sector is able to cover increasingly more complex situations. The argument, more political than economic, is that it would be cheaper if everything were done by the public sector. However, several factors lead to the use of private or public providers depending on various factors such as a shortage of human resources, differentiated technology, existing vacancies, specializations, etc.

In fact, private companies have always provided services contracted with the NHS. In other words, private services have been an integral part of the NHS since its inception. The discourse should therefore be free of prejudices between public and private. There is public health that can be supported by public, private and social providers, at market prices.

As we all know, the first health system in the country was created by a company (CUF) and later, even before the 25th of April, public servants created their own subsystem, ADSE, which was also financed by the State for decades because it relieved the activity of the SNS, as all services for these systems were largely provided by private or social hospitals and clinics.

The need for a strong NHS came from the decision to finance healthcare through taxes, thus avoiding direct financing from employers and employees. However, in the most developed countries this continues to be the way healthcare is financed, through insurance with broad coverage, but whose financing follows rules imposed by the State. When a citizen is unemployed, the State subsidizes this insurance. Citizens choose the hospital, whether public or private, since the costs of all procedures are known and negotiated in advance.

We all support a strong NHS and this should mean using all the resources we have to meet healthcare needs. In Portugal, we still have a chronic problem: the public sector controls the general accounting of its accounts, but it still needs to improve the analytical accounting of its activity in order to better negotiate with the private sector, ensuring that it pays the private sector less than its operating costs. I believe that these negotiations are already being carried out with some certainty, but we should focus on improving the value of healthcare provided by public institutions, with the rigour that the economy demands of properly allocating resources to growing needs.