Evening star. [volume] (Washington, D.C.) 1854-1972, 1962-06-10


less urgent complaints may wait
weeks. months or in some cases
even years for their turn to come
around. Private patients have no
such problem. And the recent
rapid growth of private medical in
surance policies in Britain Cfrom
10000 to over a million reflects
a growing impotence on the part
of the public.
The crux of the problem of
quality of medical care lies, OBJ
viously. in the official statement
that everyone is entitled to the
best medical services available"
There can be little doubt that
Britain's doctors are working
harder than they did before. There
can be little doubt that more
people are getting good medical
care than they did before 1913.
One of the major accomplish
ments of the system has been a
great improvement in the geo.
graphical distribution of doctors
in Britain. Since there is now no
financial advantage to the doctor
in setting up his practice in a
wealthy community, and since the
executive council must give its
approval to the setting up of a
new practice, the number of "un-
derdoctored areas" has been
steadily reduced.
On the other hand, it is also
quite obvious that the National
Health Service has enormously in
creased the demand for medical
care without increasing the
supply nearly in the same pro-
portion.
Health Expenditure
Prof. Lees, who is one of the
leading critics of the system from
an economists viewpoint, argues
that the health service, expensive
as it is, has hardly kept pace
with the cost of other services.
1t fact, actual health expendi-
ture in Britain has fallen since
l948 in proportion to the gross
national product from 4 to SO
per cent. In the same period, the
proportion in the United States
rose from "a to Al per cent.
This, in DR.. Lees opinion, I'M
derScores one Of the major evils
of the system. AS a government
monopoly, the basic decisions on
the improvement Of medical IA
cilities lie in the hands Of poll
ticianS squeezed on one side by
the desire for improvement and
on the other by an unwilling
ness to increase costs.
I'm the national health serv-
ice" he writes, 1.-The absence Of
built-in forces making for i'm
provements in quality and eff
cheney is one of its most serious
weaknesses. The most acute
danger of mis- is that is will
prevent the emergence Of more
effective methods Of medical
care"
Nor are these criticisms Just a
matter Of theory. The health
service from the beginning has
suffered from acute shortages in
many areas when measured
against the demand, notably in
the construction of new hospitals.
1t is only recently that a major
hospital building program has
got under way and it will be
many years before the shortage
is made up.
In the last few months
there has also been a major out
cry in Parliament. in the press and
from various assorted critics
about a doctor shortage as well.
The Juror revolves around the
discovery that British medical
schools are presently turning out
no more graduates than they were
in 1899. that an unusually large
number of older doctors In Brit
ain are now reaching retirement
age and that without the presence
of some 1000 non-British doctors
mostly from India and Pakistan
the whole system would be in
acute danger of breaking down.
Critics of System
These findings brought on a
controversy in the course Of
which the eminent British Medi-
cal Journal has charged fatty
that British medicine is in a
mess" Even such ardent sup
porters of the health service as
Lord Taylor, the Socialist Spokes-
man for medical matters in the
House of Lords, called it "a
pretty CHASTITY, awful picture"
and new and desperate STU
alton"
Others have gone even further.
DR.. John r. Scale, one Of the most
vociferous critics of the health
service, argues that the current
doctor shortage in Britain is
really due to the departure of
more than 500 disaffected doctors
every year for greener pastures in
New Zealand, Canada and the
United States. To back this
charge, DR.. Scale produces fig
ures of medical registrations in
these countries, showing an
alarming rise in the enrolment
of British-tra doctors since
1913.
His figures. to be sure, are hotly
rejected by other experts, both
inside and outside the health
service. The number of emigrat-
ing doctors, these experts say, is
no greater than it always has
been. And even the fuss over the
shortage of doctors has in it a
considerable political motive. I'm
fortunately the great weakness of
the health service side of this
particular argument is the ad-
mitted inability to produce accu-
rate statistics to support it.
Here again, apart from the OBJ
vious fact that "socialized medi-
cine" is not the same thing as
Utopia, it is hard for an out
slider to draw firm conclusions.
The ohVioI1S iTrnerferfioys aod