Morality in the NHS Marketplace

摘要

On Nov 5, 2013, the outgoing chief executive of the National Health Service (NHS) Sir David Nicholson announced that “privatisation and competition were not proving to be a success”.In the wake of the Health and Social Care Act, the role of the NHS has come under increasing moral scrutiny. Here, we postulate that the health-care market is morally questionable on two counts.First, in its present form, the health-care market might curtail individual liberty. The UK commissioning model currently resembles a wholesale market more closely than a retail market, with the need for a commissioning middleman. Moreover, each commissioner contracts with a fairly narrow range of providers, thereby limiting patient choice. Theoretically, providers might tender to obtain substantial market share and then exploit the inevitable wiggle room in contracts that cannot cover every eventuality. In accordance with the inverse care law, providers might prioritise patients according to lowest risk rather than greatest need. Ultimately, at the level of the patient–doctor relationship, trust might be distorted by perceived financial motives.