Saturday, November 15, 2008

And thats not all...

I see that some sections of the British media are tearing themselves apart because some survey has identified that some parameters of health care are better in Estonia than in the UK.

Well like... duh.

My experience of the Estonian health care system is very positive, while for chronic illness like cancer, they probably can not score better than Britain, since the number of patients is so small, there is little doubt that the flexibility of Estonian health care is better than in the UK. At my doctor's surgery in London I may call on Monday in order to get an appointment on Wednesday. I may not call earlier, because government targeting will not allow me to wait more than 48 hours for a doctors appointment. In Estonia I can call whenever I wish and an appointment is usually available within the same day or at the very least at a time at my convenience.

Of course the Daily Mail -which is particularly cross about this Estonia comparison- probably thinks that Estonia is a third world state, rather than the rather Scandinavian place that it is, so the presence of Doctors probably comes as a slight surprise, but of course other Scandinavian countries also score better than Britain in a range of health care issues. However what should shock anybody in the UK is that this better service exists pretty much across the board in public services, despite the fact that the Estonian tax burden is quite a bit lower than in the UK.

Both Tory and Labour governments have imposed external performance measurement without understanding that such measures distort what they are trying to measure. In Estonia, as in the rest of Balto-Scandia, there is a more hands-on sense of responsibility amongst professionals.

Because Doctors, Matrons or Nurses have to take responsibility for their own actions, they don't need professional administrators. the result is a far lower cost and a far more efficient delivery of service.

British politicians will insist on trying to second guess things, whether that is the market mechanism or the delivery of health care.

Since most British politicians have no executive experience at all, it is easy to see why they are only able to deliver expensive, inefficient and low quality services.

Now they have taken over the banks, it is no wonder that the global markets are not exactly alive with confidence in UK PLC, and frankly- despite his self confident comments- if George Osborne were in charge I suspect that market confidence would be even lower.

If Vince Cable were in charge, on the other hand, I think things would be rather different...

5 comments:

Jock Coats said...

Okay. I was trying to construct an argument a few days ago about how "big" or "small" a state needs to be for an optimal welfare/safety net system. The problem I found with the Baltic states is that their Gini index is quite high (though Britain's is higher than the EU27 average too). So, is there a problem with poverty in the Baltic states? Do they find they have to spend less on poverty reduction because individuals take more reponsibility in that area too? Malta looks like a good example too.

Cicero said...

Interesting question. Although the Gini is historically quite high, the actual numbers of people at each end of the spectrum is pretty small. The Baltics do not have the community support that is said to exist in Mediterranean societies and in fact a particular problem is poverty amongst pensioners, especially Russian speakers who do not have family in the Baltic. None of this is particularly positive for those at the bottom today, however the increase in social insurance is creating a safety net way above the current situation.

Jock Coats said...

Yes, I agree Gini is not a terribly useful measure other than as a rough comparison between different countries. I notice even that some countries count their Gini co-efficient before welfare payments and some after.

But it was only one indiciator for my argument! I was particularly interested for example in health services and outcomes, and here it appears that smaller states in a similar sort of overall "wealth bracket" with comparison bigger states (such as in Europe) seem to do better.

I'm just fed up of being part of a mass of sixty million of us being administered bureaucratically as if there was little difference between us!

Cicero said...

Yes I agree. In my view this is indeed an argument for a highly decentralised federal state. different outcomes can hardly be tarred with the epithet "post code lottery with the local residents have voted for them...

kiki said...
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