England vs. Scotland
Does More Money Mean Better Health?

By Benedict Irvine & Ian Ginsberg
June 2004
CIVITAS
ISBN: 1903386357
255 pages, 5 ½" x 8 ½"
$25.00 Paper Original

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The poor performance of the NHS in international league tables is often attributed to the low expenditure per head of population. A standard response to criticism of its failings has been to demand higher government expenditure. And yet, within the UK we can compare health expenditures and outcomes in Scotland and England to find out if more money is the answer.

Expenditure on health is higher in Scotland. There are more doctors, dentists and nurses per head of population than in England. There are more specialists. There are more radiotherapy machines, more screening programs, more specialist stroke units and more acute beds. In spite of this, life expectancy is shorter in Scotland. Morality from strokes and major cancers is higher. If more money does not necessarily guarantee better health, the answer to the poor performance of the NHS might lie elsewhere.

Some argue that deprivation lies behind performance deficits in Scotland, but the authors of this study suggest that the way in which money is raised and spent is as important as how much is spent. Health policy makers should look at the social insurance systems of countries like Germany, France, the Netherlands and Switzerland, all of which produce better outcomes than our tax-funded and politically managed NHS.

Health Care

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