4 ms·

Both underfunding and overfunding can cause inefficiencies, there is a sweet spot in the middle where an organisation would be at its most efficient. It's quit

Both underfunding and overfunding can cause inefficiencies, there is a sweet spot in the middle where an organisation would be at its most efficient. It's quite clear that the NHS has been underfunded, and under resourced, for the last decade. However the government still try to argue that the inefficiencies are a organisational problem rather than a funding problem. Which is still laughable when they have presided over it during the whole time period in question.

badcppdev 4y ago
And to be clear if you have an overfunded health system then you are providing good medical treatment to your population in a timely manner. You're just spending more money doing it than you might otherwise do so. So someone with ethics might argue that if you are in an uncertain area between over and underfunding then it will kill fewer people to err on overfunding.
- newsclues 4y ago
  Overfunding doesn't always result in effective or good service/products. If management doesn't flow the extra funding to front line staff or resources, it can easily be wasted for zero added value.
  - TheOtherHobbes 4y ago
    Which is exactly how the semi-privatised NHS operates. Agencies have been encouraged to set up as independent service providers who can profiteer by price gouging the NHS while paying nurses and doctors pocket money. Renationalising the NHS and limiting the private sector to those few expensive services that are essential would fix this. But both political parties are working for the people who profit from this situation.
- rcarr 4y ago
  They would be better off addressing the root causes that are sending more and more people to the NHS in the first place. Healthy food needs to be cheaper than unhealthy food, physical exercise needs to be encouraged at a grass roots level, working conditions need a massive overhaul, education needs to improve, salaries need to rise and/or rents need to fall, and housing needs to be of better quality, particularly around insulation. At the minute we’re treating the symptoms and not the cause of the disease.
- gmac 4y ago
  Not necessarily: my understanding is that in the US a few people probably get more healthcare than the optimum, and many get less, all on an extremely large budget.
  - badcppdev 4y ago
    Yes you're correct. I'm not sure I can fix my definition. Would probably have to rip it up and start again. Something involving killing patients if you don't build some leeway into the system.
- nradov 4y ago
  What does overfunded even mean for a health system? Some patients with serious complex conditions can consume an effectively infinite amount of healthcare services, especially if we want to take heroic measures to keep them alive a bit longer. I don't think there is any amount of funding that could realistically be put in that would make the UK NHS overfunded; you can only compare funding and outcomes relative to other developed countries.
lbriner 4y ago
The "funding" problem that I never see discussed is that the NHS costs massively more per-person now than when it was introduced. ex. How many ambulances at a few pounds in 1948, which were vans with a stretcher in the back and a couple of blokes to drive it. What about 2022? The cost, roughly £150K for the ambulance, goodness knows what to train up ambulance technicians and paramedics. If the kit is broken, the ambulance can be out of service, which means more units to provide cover (or not if you can't afford it!). The on top of all that, many more people go to hospital because the care is leagues above what you got in 1948. Ditto for equipment costs like Digital XRays, MRIS etc. All of that is not surprising or even undesirable but it would be interesting to see the additional tax that you should be taking per-person to pay for all of this additional equipment. If the NHS costs around 30% of expenditure i.e. 30% of my tax then roughly 7.5% of my income covers the cost of the NHS, maybe £6K per year. When we look at things that way, you can see why the Government doesn't want to take any money in tax because that sounds like a lot of money. You can also see how they can't reduce costs by going backwards in replacing high-tech with no-tech.
- rcarr 4y ago
  From what I read it’s not the equipment, but a bloated layer of bureaucratic management on massive salaries that is the real issue. The front line staff get pittance in comparison.
  - daedalus_f 4y ago
    NHS management overhead takes up approximately 8% of the total NHS budget [1] In the US that number is more like 15-20% [2]. [1] https://www.kingsfund.org.uk/projects/health-and-social-care-bill/mythbusters/nhs-managers https://www.kingsfund.org.uk/projects/health-and-social-care... [2] https://jamanetwork.com/journals/jama/fullarticle/2785479 https://jamanetwork.com/journals/jama/fullarticle/2785479
    - rcarr 4y ago
      > It is extremely difficult to find an accurate figure for the number of managers in the NHS, and most sources of information use different definitions for who is counted as a manager. I’m not sure I can take the report seriously after that. You can’t write a report on management in the NHS and refuse to give a definition of manager. Also, how many of these managers are directly employed by the NHS and how many are employed as consultants? I’m not saying you’re necessarily wrong but that report is hand wavey.
truculent 4y ago
In the case of the UK and NHS, under/overfunding doesn't quite capture the whole issue. The nature of spending matters, too. More spending on capital and managerial expertise could help improve things, but has largely been neglected due to political concerns regarding efficiency (or, perhaps, perceived efficiency).
- smcl 4y ago
  The NHS is also suffering as a result of other departments' cutbacks: https://www.theguardian.com/society/2022/nov/13/hospital-beds-england-occupied-patients-fit-discharge https://www.theguardian.com/society/2022/nov/13/hospital-bed... The tl;dr here is that there's a striking number of patients in hospitals (up to 30% in some areas) which are ready to be discharged from hospital, but cannot yet be discharged since they're waiting for the availability of social services that aren't handled by the NHS. I've mentioned it in all my comments here but this is the cost of austerity, and it's making healthcare not just worse but more expensive.
onlyrealcuzzo 4y ago
Austerity IIUC is more about reducing the deficit than reducing spending. Usually the way you achieve this is by reducing spending to reduce the deficit. But you could also increase taxes. Government spending will eventually be paid. It's whether it gets by the people now, the people in the future, or the bagholders (bond holders when the government or currency collapses). Of course life expectancy is going to decline if you can't force your grandchildren to pay for your healthcare costs now. But it's not clear to me that's the most evil thing in the world. Back when most spending was infrastructure and growth was high, you could argue this would be around forever, and it should be financed to a large degree on future generations. But now that a huge percentage of spending is entitlements and growth has slowed, it's less clear.
- gmac 4y ago
  The thing about austerity, though, is that by reducing spending you also shrink the wider economy, reducing tax receipts. The "nation's credit card" rhetoric the government has used to try to justify this is just misleading. Oxford prof Simon Wren-Lewis explains it better than I could: https://www.lrb.co.uk/the-paper/v37/n04/simon-wren-lewis/the-austerity-con https://www.lrb.co.uk/the-paper/v37/n04/simon-wren-lewis/the...
atoav 4y ago
> Both underfunding and overfunding can cause inefficiencies, there is a sweet spot in the middle where an organisation would be at its most efficient. I can't help but think that efficiency should be a secondary metric when it comes to health care. If you can get the same treatment, capacity, resilence etc. cheaper, go for it – sure. But as soon as you start to save money by sacrificing those more important metrics the price will be paid in human lifes eventually.
- nradov 4y ago
  Every society has limited resources that it can afford to spend on healthcare, regardless of whether that funding comes from public or private sources. It is simply impossible to deliver unlimited, high-quality care to everyone. So, if we want to do the greatest good for the greatest number of people then the only option is to maximize efficiency.
  - atoav 4y ago
    > It is simply impossible to deliver unlimited, high-quality care to everyone. Anything "unlimited" is impossible in a constrained physical world. So I am not sure what contribution you like to make by stating the obvious here. For most economies delivering reasonable high quality care to everyone who needs it is totally a thing they can (and in some cases: do) afford. It is just a matter of priorities. You would be surprising what nations can sustain if they really want it. War is a good example. When a nation goes into a long war and changes its economy to support that war we call that a war-economy. It is an economy, that priorizes a lot of what it produces and outputs for the war effort. Nations can be years or even decades in war-economy mode without going under and that works because they priorize the nations existence (and thus the war) above other financial goals. And in war nations also make companies do things that would be otherwise unthinkable, e.g. make a company share blueprints with a competitor, favour certain industries with resources, etc. If any nation knows that, it would be the UK. So if any modern western government goes all cheap and naive big eyes on health care, it is not because they can't do better, but because they don't want to. Not wanting to do better is a very easy opinion to have, especially if one earns money by being of that opinion. Those who suffer and die are also a different demographic than them, so even easier to pretend all is going well. I am not saying that any health care system should be inefficient. It should be efficient in certain way (e.g. prevent funneling government money into pockets, prevent paying too much for medicine and equipment and so on). But efficieny is not the primary goal here, the primary goal is to have an adequate health care system. And you will always get unethical rich people saying private payer is adequate, because THEY are covered by it. But the fact of the matter is that everybody profits when a nation has a good working health care system for all, even the rich egomaniacs. After all they cannot decide where they will have a medical emergency as well.

badcppdev 4y ago

And to be clear if you have an overfunded health system then you are providing good medical treatment to your population in a timely manner. You're just spending more money doing it than you might otherwise do so. So someone with ethics might argue that if you are in an uncertain area between over and underfunding then it will kill fewer people to err on overfunding.

newsclues 4y ago
Overfunding doesn't always result in effective or good service/products. If management doesn't flow the extra funding to front line staff or resources, it can easily be wasted for zero added value.
- TheOtherHobbes 4y ago
  Which is exactly how the semi-privatised NHS operates. Agencies have been encouraged to set up as independent service providers who can profiteer by price gouging the NHS while paying nurses and doctors pocket money. Renationalising the NHS and limiting the private sector to those few expensive services that are essential would fix this. But both political parties are working for the people who profit from this situation.
rcarr 4y ago
They would be better off addressing the root causes that are sending more and more people to the NHS in the first place. Healthy food needs to be cheaper than unhealthy food, physical exercise needs to be encouraged at a grass roots level, working conditions need a massive overhaul, education needs to improve, salaries need to rise and/or rents need to fall, and housing needs to be of better quality, particularly around insulation. At the minute we’re treating the symptoms and not the cause of the disease.
gmac 4y ago
Not necessarily: my understanding is that in the US a few people probably get more healthcare than the optimum, and many get less, all on an extremely large budget.
- badcppdev 4y ago
  Yes you're correct. I'm not sure I can fix my definition. Would probably have to rip it up and start again. Something involving killing patients if you don't build some leeway into the system.
nradov 4y ago
What does overfunded even mean for a health system? Some patients with serious complex conditions can consume an effectively infinite amount of healthcare services, especially if we want to take heroic measures to keep them alive a bit longer. I don't think there is any amount of funding that could realistically be put in that would make the UK NHS overfunded; you can only compare funding and outcomes relative to other developed countries.

lbriner 4y ago

The "funding" problem that I never see discussed is that the NHS costs massively more per-person now than when it was introduced. ex. How many ambulances at a few pounds in 1948, which were vans with a stretcher in the back and a couple of blokes to drive it. What about 2022? The cost, roughly £150K for the ambulance, goodness knows what to train up ambulance technicians and paramedics. If the kit is broken, the ambulance can be out of service, which means more units to provide cover (or not if you can't afford it!). The on top of all that, many more people go to hospital because the care is leagues above what you got in 1948. Ditto for equipment costs like Digital XRays, MRIS etc. All of that is not surprising or even undesirable but it would be interesting to see the additional tax that you should be taking per-person to pay for all of this additional equipment. If the NHS costs around 30% of expenditure i.e. 30% of my tax then roughly 7.5% of my income covers the cost of the NHS, maybe £6K per year. When we look at things that way, you can see why the Government doesn't want to take any money in tax because that sounds like a lot of money. You can also see how they can't reduce costs by going backwards in replacing high-tech with no-tech.

rcarr 4y ago
From what I read it’s not the equipment, but a bloated layer of bureaucratic management on massive salaries that is the real issue. The front line staff get pittance in comparison.
- daedalus_f 4y ago
  NHS management overhead takes up approximately 8% of the total NHS budget [1] In the US that number is more like 15-20% [2]. [1] https://www.kingsfund.org.uk/projects/health-and-social-care-bill/mythbusters/nhs-managers https://www.kingsfund.org.uk/projects/health-and-social-care... [2] https://jamanetwork.com/journals/jama/fullarticle/2785479 https://jamanetwork.com/journals/jama/fullarticle/2785479
  - rcarr 4y ago
    > It is extremely difficult to find an accurate figure for the number of managers in the NHS, and most sources of information use different definitions for who is counted as a manager. I’m not sure I can take the report seriously after that. You can’t write a report on management in the NHS and refuse to give a definition of manager. Also, how many of these managers are directly employed by the NHS and how many are employed as consultants? I’m not saying you’re necessarily wrong but that report is hand wavey.

truculent 4y ago

In the case of the UK and NHS, under/overfunding doesn't quite capture the whole issue. The nature of spending matters, too. More spending on capital and managerial expertise could help improve things, but has largely been neglected due to political concerns regarding efficiency (or, perhaps, perceived efficiency).

smcl 4y ago
The NHS is also suffering as a result of other departments' cutbacks: https://www.theguardian.com/society/2022/nov/13/hospital-beds-england-occupied-patients-fit-discharge https://www.theguardian.com/society/2022/nov/13/hospital-bed... The tl;dr here is that there's a striking number of patients in hospitals (up to 30% in some areas) which are ready to be discharged from hospital, but cannot yet be discharged since they're waiting for the availability of social services that aren't handled by the NHS. I've mentioned it in all my comments here but this is the cost of austerity, and it's making healthcare not just worse but more expensive.

onlyrealcuzzo 4y ago

Austerity IIUC is more about reducing the deficit than reducing spending. Usually the way you achieve this is by reducing spending to reduce the deficit. But you could also increase taxes. Government spending will eventually be paid. It's whether it gets by the people now, the people in the future, or the bagholders (bond holders when the government or currency collapses). Of course life expectancy is going to decline if you can't force your grandchildren to pay for your healthcare costs now. But it's not clear to me that's the most evil thing in the world. Back when most spending was infrastructure and growth was high, you could argue this would be around forever, and it should be financed to a large degree on future generations. But now that a huge percentage of spending is entitlements and growth has slowed, it's less clear.

gmac 4y ago
The thing about austerity, though, is that by reducing spending you also shrink the wider economy, reducing tax receipts. The "nation's credit card" rhetoric the government has used to try to justify this is just misleading. Oxford prof Simon Wren-Lewis explains it better than I could: https://www.lrb.co.uk/the-paper/v37/n04/simon-wren-lewis/the-austerity-con https://www.lrb.co.uk/the-paper/v37/n04/simon-wren-lewis/the...

atoav 4y ago

> Both underfunding and overfunding can cause inefficiencies, there is a sweet spot in the middle where an organisation would be at its most efficient. I can't help but think that efficiency should be a secondary metric when it comes to health care. If you can get the same treatment, capacity, resilence etc. cheaper, go for it – sure. But as soon as you start to save money by sacrificing those more important metrics the price will be paid in human lifes eventually.

nradov 4y ago
Every society has limited resources that it can afford to spend on healthcare, regardless of whether that funding comes from public or private sources. It is simply impossible to deliver unlimited, high-quality care to everyone. So, if we want to do the greatest good for the greatest number of people then the only option is to maximize efficiency.
- atoav 4y ago
  > It is simply impossible to deliver unlimited, high-quality care to everyone. Anything "unlimited" is impossible in a constrained physical world. So I am not sure what contribution you like to make by stating the obvious here. For most economies delivering reasonable high quality care to everyone who needs it is totally a thing they can (and in some cases: do) afford. It is just a matter of priorities. You would be surprising what nations can sustain if they really want it. War is a good example. When a nation goes into a long war and changes its economy to support that war we call that a war-economy. It is an economy, that priorizes a lot of what it produces and outputs for the war effort. Nations can be years or even decades in war-economy mode without going under and that works because they priorize the nations existence (and thus the war) above other financial goals. And in war nations also make companies do things that would be otherwise unthinkable, e.g. make a company share blueprints with a competitor, favour certain industries with resources, etc. If any nation knows that, it would be the UK. So if any modern western government goes all cheap and naive big eyes on health care, it is not because they can't do better, but because they don't want to. Not wanting to do better is a very easy opinion to have, especially if one earns money by being of that opinion. Those who suffer and die are also a different demographic than them, so even easier to pretend all is going well. I am not saying that any health care system should be inefficient. It should be efficient in certain way (e.g. prevent funneling government money into pockets, prevent paying too much for medicine and equipment and so on). But efficieny is not the primary goal here, the primary goal is to have an adequate health care system. And you will always get unethical rich people saying private payer is adequate, because THEY are covered by it. But the fact of the matter is that everybody profits when a nation has a good working health care system for all, even the rich egomaniacs. After all they cannot decide where they will have a medical emergency as well.