sexta-feira, setembro 17, 2004
Serviços de Saúde Estatais: O caso Inglês
Um recente estudo do CNE acerca do SNS relata um serviço ineficiente e sobrelotado e propõe a privatização dos cuidados de saúde em Inglaterra.
In February 1944 the British government published a white paper entitled A National Health Service. It proposed that everybody "irrespective of means, age, sex or occupation shall have equal opportunity to benefit from the best and most up-to-date medical and allied services available; that the service should be comprehensive for all who wanted it; that it should be free of charge; and that it should promote good health "rather than only the treatment of bad".
In 1948, just weeks before the appointed day of the National Health Service's launch, the government issued a leaflet to every home in the country. It promised that the NHS "will provide you with all medical, dental and nursing care". Everyone " rich or poor "can use it". Today, more than half a century on, it is clear that the NHS has never delivered on its promise.
Whilst the NHS was created to treat the whole population in an equitable manner and according to need, in practice, the historical evidence suggests its impact has been otherwise. Professor Julian Le Grand has shown that relative to need people in the professional and managerial classes receive more than 40 per cent more NHS spending per illness episode than those in the lower semi- and un-skilled classifications.
Today, the NHS has one million people on its waiting lists. Each year in its hospitals, more than 100,000 patients contract infections and illnesses that they did not have prior to being admitted.14 And according to the Malnutrition Advisory Group up to 40 per cent of NHS hospital patients were undernourished during inpatient stays.
Back in 1944, Bevan's White Paper, A National Health Service, estimated that the service would cost taxpayers £132 million per year. However, this was revised upwards to £152 million in 1946 and again to £230 million just before the Act came into force in July 1948. In its first year of operation, 1949-50, the NHS actually ended up costing the taxpayer £305 million and required a supplementary estimate of £98 million.
The inaccuracy of the estimates can be attributed to a number of factors. The first was that the early projections of cost assumed that demand would remain roughly constant despite there being no price constraints on demand "the service being free" at the point of use. Secondly, contemporary social and medical developments exacerbated the problems created by an absence of any price constraints on demand, not least because medical advances at the time meant that there was a dramatic expansion in the type and range of health services that could be made available.
To keep demand in check the service deliberately rationed supply ? through scarcity rather than price. While doctors who worked in NHS hospitals had been encouraged at first to treat their patients according to need the imposition of cash limits soon turned them into allocators of scarce resources. More than minimal care was denied to cases where there was little chance of successful recovery, particularly to young children or the elderly with seriousconditions. Indeed, health care for everyone else was provided sparingly by international standards.
The supply of health care has again been rationed still further by queuing. Crowded waiting rooms are common in most general practices and outpatient departments. And queues have become a fact of life for in-patients, often with long waiting periods for those operations given priority.
More than half a century on since the NHS?s inception it is clear that in reality people have never had a meaningful right to free and equal treatment on demand. What they have had - in the main - is an unlimited right of access to a waiting list from which - with a few exceptions - they will not be excluded.
posted by Miguel Noronha 2:10 da tarde
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