GP shortages signal NHS failures

Young people want to live in cities, and young doctors are no different. This is true not only for the UK but for much of Europe – and in Europe the effects of rural depopulation are far more pronounced. It is this metro-centricity that is being blamed for what the Telegraph terms an alarming crisis in rural NHS GP provision. Yet not everywhere that experiences rural depopulation also experiences GP shortages – here in Austria, for example.

A shortage of GPs in rural areas can only be because of two reasons. Either the nation does not have enough GPs, or we have enough overall but imperfections in the GP employment market create surpluses of GPs in the cities and shortages in rural areas. In the UK, both problems can be laid at the feet of NHS mismanagement. It has failed, just like any centrally planned economy. It has failed because the NHS distorts the employment market.

Here in Austria everyone pays into social insurance firms – there are several – that also run hospitals and clinics. GPs are self-employed, and hang their shingle wherever they judge they can earn a living. Some GPs have more than one surgery. Commonly, they work alone – which is not a problem when they’re away on holiday (which is frequently) as insured citizens can use any GP; there’s no such thing as being registered with just one. Consequently, their skills are offered to the market on very much a commercial basis; If I like Dr Musterman, I can take my business to his ordination, if not I can see young Dr Wächter down the road. An E-card confirms one is insured. For each visit, the GP is paid €18.86 by the social insurance firm and the insured pays a premium of €3.77 on their insurance cost. Of course there are central government subsidies in various forms to the social insurance providers so it is not wholly like the US insured model (for a start, my health insurance is only about €45 a month), but this mix of health by both tax and free market mechanisms works – at least to the extent of ensuring there are plenty of GP surgeries in rural areas.

You see, the reason that UK doctors give to the Telegraph for not wanting to work in rural and coastal practices – the pressure of high numbers of elderly people – is the very reason that Austrian GPs hang their shingle in such places. Old people are good business, if you’re paid per consultation.