'Covert Rationing' Is A Feature Of Single-Payer Health Care

About a week ago Elizabeth Price Foley wrote a very nice piece entitled “VA Scandals Raise The Specter Of Healthcare Rationing” at the Daily Caller.  However, this one paragraph caught my eye:

Rationing care can take many forms. It can be overt, like the Canadian or British health care systems, which have unambiguous, publicly-announced waiting times and coverage denials for certain procedures. Or rationing can be more subtle, with little or no public participation. This latter, covert form of rationing is what the VA has adopted.

In recent years, though, Great Britain’s NHS has engaged in plenty of covert rationing in addition to the overt kind.  (I suspect Foley knows this and was merely making a distinction and not implying officials in Britain’s NHS don’t try to hide its rationing when they can.)

As the below stories show, NHS administrators seem to live in a culture of hiding information that reflects poorly on them—British hospitals even hide data on patient dissatisfaction with the food.

So, why do the people who run hospitals in the NHS hide data on waiting lists and the like?  For starters, their patients aren’t their customers.  In other markets, if a business inconveniences their customers too much, the customers take their money elsewhere.  The business eventually shapes up or goes under.  With the NHS, the funding comes from government and it keeps coming, regardless of how poorly patients are treated. 

There might be some consequences if the politicians see ever-increasing waiting times.  However, politicians are not likely to interview actual patients but will instead rely on data in government reports.  If you fudge the data the politicians see, then politicians may think the NHS is doing better than it is, and as a NHS administrator you are off the hook—heck, you might even be in line for a promotion.

Unless, of course, someone blows the whistle and the press gets a hold of it.  In that case a few heads can roll.  But notice that in the previous paragraph I wrote there “might” be consequences.  Read this story about the 1,200 deaths due to incompetence at Mid-Staffordshire NHS Trust.  At the time, “Not a single official [had] been disciplined.”

With that said, below are excerpts from stories about “covert rationing” in the NHS.  And keep in mind these came on the heals of a government crackdown on “hidden waiting times” back in 2011.

-Daily Mail, April 28, 2014:

Errors in hospital waiting list times have undermined public confidence in the data, claims a public spending watchdog. 

The Public Accounts Committee called for independent audits in future after spot checks found one in four hospitals recording false waiting list times.”

-BBC, February 12, 2014:

Colchester Hospital chief ‘to get grip’ after cancer scandal.

The interim head of a hospital says she will focus on getting a “grip” on its problems after staff said they were bullied into falsifying patient data.

A police inquiry began at Colchester Hospital after a health watchdog found “inaccuracies” with waiting time data relating to cancer treatment.

Seven whistle-blowing investigations are currently under way at the hospital, the the BBC has learned.

-BBC, January 23, 2014:

NHS waiting time data for elective surgery ‘unreliable’.

Patients in England cannot rely on information on waiting times for non-emergency operations, such as knee and hip replacements, a watchdog says.

The National Audit Office (NAO) found wrong and inconsistent recording after reviewing 650 cases in seven trusts.

The watchdog said it was unable to discern whether this was deliberate, but overall the practices concealed delays rather than over-recorded waits.

-Telegraph, February 21, 2013:

Audit Scotland found the proportion of patients marked as “socially unavailable” to attend appointments had risen from 11 per cent to more than 30 per cent as ministers imposed more stringent deadlines….

While official figures showed only three per cent of in-patients were waiting longer than the target nine weeks in June 2011, auditors found that the real figure was 23 per cent when periods of ‘unavailability’ were included.

Audit Scotland could not state definitively that boards had deliberately fiddled the system to meet their targets because there are few records stating why patients were deemed to be unavailable.