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National Insurance [NI] is a tax that should be repurposed

NI is a type of ‘insurance’ that morphed into a tax which in reality is a just another type of tax on income. It is used to pay for things like the NHS and other public benefits.

BUT, is it really optimised for 21st century healthcare especially in countries like the UK which have highly constrained healthcare systems (Goldratt).

Better to unbundle the NI contribution to return the money to taxpayers as an NHS co-pay instead.

I don’t think the past 30 years has shown that the C-Suite in the NHS are able to drive the necessary reform and government has not given the NHS and the patients the tools.

We are clearly at a hinge point with respect to healthcare, and if you want revolutionary reform of the NHS so the extra money really does something useful, then as DeBono would say, you don’t have a problem, but a crisis and need to try something completely new.

Putting more cash into consumers hands (think France or Japan with high co-payments) can incentivise reform and create new healthcare delivery models for healthcare professionals to work in.

Dranove and Lawton’s Big Med [] is instructive in noting how US healthcare policy has disenfranchised the medical cost-drivers by trying to convert them into jobbing care providers, with skin the game.

Keep in mind that in many countries such as the UK, hospitals are monopoly employers of doctors/consultants who are the cost drivers. Evidence shows that enfranchising doctors (e.g. gain-sharing) helps them realise the benefits of change. But as they say, “you gotta wanna”.