Trying to settle an argument with an American friend related to costs of socialised medicine in the uk.
The current argument relates to the over-staffing inherent in social medicine - I’m trying to find out figures for the overall figure paid out in salaries in the NHS (England and Wales only, Scotland is separate), but can’t find it in a single figure anywhere. I know it’s somewhere between 40-60% of the overall budget, but would like some solid figures to back me up.
Anyone got better google-fu than me and can dig it out?
I can’t help with any GQ-type statitistics, but may I point out that, even if you find the info on salaries, it may not answer your question .
I live in a socialized medicine country, and I see no evidence of over-staffing. In fact, I’ve seen American hospitals with more nurses avaible than in my country
Even if salaries are such a large proportion of the total budget, it does not mean that there is “over staffing”. It may be that the NHS performs much less lab testing, etc, or has many fewer expensive pieces of machinery to maintain, etc.
Any time you see a figure of salaries as a percentage of total costs, there’s accounting hanky-panky going on somewhere. Ultimately, all costs are salaries, and you can get any figure you want just by probing to different depths.
Overstaffing? Huh? In Canada, there’s a shortage of staff. the first thing they do is freeze the pay of other staff and cap the billing of doctors; cut back on everything, reduce the number of hospital beds - which results in shortages, followed by sudden realization it was a bad idea, and proper balance restored for a short while…
I understand some NHS / UK locations pay salaries; but the Canadian system basically pays billings to doctors for procedures; I.e. so many dollars for a regular GP checkup, etc. Just like the market system in the US, the doctor then has to pay his nurse, receptionist, rent on the offices, supplies and overhead, etc. Figuring out exactly what goes into his pocket as wages is an impossible task. However, GP’s in Canada don’t make a great deal of money take-home - in the low hundred thousand plus range, if I had to guess. Most specialists still have office overhead, as a surgical procedure likely requires a consult or several in the office before the operation.
OTOH, I recall a discussion once that said malpractice insurance for US doctors was quite high, although another thread tells me this is not the case; anyway, lawsuits and malpractice costs are very much lower in Canada.
Overstaffed?! Which NHS are you thinking of? My depatment is currently running on the bare bones of staff we can get by on and we’ve been instructed to cut the wages bill by (IIRC) 15% in the next year. The NHS I’ve worked in for 6 years (3 different departments in 3 different hospitals) benefits from hours and hours of unpaid overtime, untaken breaks and extra miles gone by staff who care too much about their jobs and the patients to leave things undone. There may be parts of the NHS that are overstaffed, but they are by far in the minority.
Sorry, to be a bit clearer the argument is whether there’s an additional management overhead in running a massive socialised medicine programme, or whether economies of scale mean more front-line staff and fewer managers/back-office requirements.
So while the NHS might be understaffed in terms of front-line practitioners, there is still a need for “Integrated Whole Systems Care Pathway Managers” and other such roles.
Not sure whether that’s inherent in socialised medicine - i.e. whether the private sector weeds out the unncessary roles and focuses on those jobs needed for delivery.
And I don’t necessarily agree that “all costs as salaries” - the drugs budget for the NHS is huge and isn’t linked to the numbers of staff?
It is not just economies of scale that lead to fewer managers being needed in a socialized system. Much of the bureaucratic work that has to be done in running a system like the American one simply does not have to be done at all. In America, tremendous numbers of man (or, probably, mainly woman) hours go into checking if particular individuals have insurance, what insurance they have, and precisely what treatment options that entitles them to. Then, when this process gets screwed up (as seems to happen quite often in my experience) and people are denied coverage to which they are actually entitled, or they think they are entitled to coverage that they really are not, many more hours of patient, doctor’s office, and insurance company worker’s time goes into sorting things out (or attempting to).
None of that has to be done in the NHS or similar socialized systems. Everybody is entitled. Everybody has the same entitlements.
Yes, it still needs bureaucrats, but many fewer, not more.
The idea that privately run bureaucracies are necessarily more efficient is a complete myth.
Would looking up some Report and Accounts for the NHS be the place to start? I don’t have time to hunt around myself, but checking out the publications at the Department of Health might be a starting point.
When discussing over-staffing, is your friend including the staff in the insurance industry that performs many of the same functions that the managers in NHS do? I find it very hard to believe that the US gets by with fewer managers. We have an entire industry of nothing but managers.
The NHS’s budget for 2010-2011 is £102.3 billion, which impies a wage bill of around £60 billion.
Further data from that page that are especially relevant to your question:
*The NHS currently employs 133,662 doctors, 408,160 qualified nursing staff, and 39,913 managers.
Managers and senior managers accounted for 2.9 per cent of the 1.3 million staff employed by the NHS in 2008
In 2008/09 the management costs of the NHS had fallen from 5.0 per cent in 1997/98 to 3.0 per cent.
While the NHS spends 3 per cent of its budget on management costs, equivalent figures for hospitals in Canada and the USA are 10 per cent and 17 per cent respectively.*
This is true in Canada too. Almost everyone the doctor sees is covered by the provincial health plan. The doctors are well aware what’s covered. Only optional things like vanity cosmetic surgery tend to not be covered. Submit procedure and patient medical number, get reimbursed. One simple form, one payer. (Out-of-province etc. more likely to end up at emergency rooms where they know the unusual billing processes.)
Private bureaucrcies are efficient when the market requires them to be. However, in a system like the USA, it’s not really a free market. Switching plans is awkward and leads to loss of coverage; the insurer can raise rates arbitrarily; and the person paying the bill - the employer, usually - is not the one consuming the service so cannot make the quality-for-service determination nor the valu-for-money determination. Basically, until it becomes highway robbery and loses customers, the insurer can do whatever the heck they want. This is the opposite of inducing efficiency.
You also need to know that a significant number of those managers are actually directly involoved in medical practice.
The most senior nursing staff are usually regraded to managers, but wha they actually do is manage and run units or wards, they may be responsible for managing morejunior nurses, but in essence they themselces are still medical practitioners and are often to be found carrying out that work.
The number of managers who have nothing at all to do with direct medical practice is less than the figure given. Most of the remaining managers will be responsible to running departments such as building services and maintenance, or involved with purchase contracts for almost anything you can imagine.
If you compare this with the US system, I would expect that most of their maintenance is done through contractors rather than direct employment model of our NHS. In others words, the US system probably has a lot of hidden managers at the end of some contract service arrangement. It’s highly probable we are not comparing like with like, perhaps it would be better to ask how many staff, direct employed or otherwise are involved in non-medical management.
Aha. In business, tehse are called “team leads”. They do some of the work, plus supervise, but without a manager title are paid much less.
Good old contracting out. Another paragon of US business efficiency. When the place I worked with hired a contract agency to program, the owner eventually bought himself a Porsche. I pointed out to the boss (unappreciated) that the only thing stupider than giving someone a Porsche at $100/hr plus expenses, for writing a program, was giving A a Porsche because B wrote a program. Needless to say, B saw very little of that $100/hr, being an uneducated whiz kid without the formal credentials to get himself a real job.
The real inefficiency of the American system has to be the dual bureaucracy to scrutinize each payment application; first by the medical facility billing it, then by the insurers receiving it.
By contrast, what is the inefficiency of a government system under intense budgetary pressure? (They always are). The ability to hide managerial incompetence (i.e. stuff does not get ordered, etc.) and the ability of unions to prevent lazy or incompetent workers outside the front lines of medicine (maintenance staff, clerical, etc.) from being fired. Nurses or doctors whose work endangers patient are usually easy to let go. Both problems are usually somewhat easy to correct with good manageent - which is another issue…
In the NHS, staff are often bumped up a grade to do the same work just to retain them, or they will just go elsewhere, especially in the London region. hey have a habit of moving to the provinces where they can afford to live on the National Wage schemes. What happens is that you get, ‘grade inflation’ where people in cheaper areas are doing much the same work in l their lower grades, as those in expensive areas on higher grades.
I have seen staff move from the London region on a particular staff grade, but when they come up here to Yorkshire, they are simply not as capable as the staff under them, and its all because of ‘grade inflation’, In this part of the country they simply would not have been promoted to the level they hold, because they are not good enough.
Certain occupations are easier to get into in the London region because of this constant staff turnover, firemen, teachers, social workers etc, and once they have completed their training and probationary period, they move out, some move there from our region, get themselves into the job in London and then move back.
Jobs are harder to come by around here, you have to run harder just to stand still.
So we have this system, call someone a manager, keep their pay the same, but they are now more satisfied because of the adidtion to their name badge.
Welcome to the looking glass world of regional pay and regional living cost variations.
One of the big thrusts of the current wave of cost cutting is without any doubt at all, to move heavily London based state agencies into the regions, where everything costs less, the workers are better qualified and are grateful to have stable and secure employment - its been going on some time now, but it is going to accelarate.
See for all the shite that our UK media talks about Public sector workers wages and pensions, the reality is that the wages paid in this sector are generally below, a large amount lower in some professions than general market rates in London and the big conurbations, the only reason they can hire is because of job security, take that away and you will lose your staff, and I see it even today where applicants for posts are not even turning up for interview, the jobs they were applying for have just been rated with lower starting pay so the pay band is much wider.We will end up with staff of lower ability, already seen it happening, the more able ones can always find a decent income elsewhere.
Its utterly disgraceful that someone working a full week is paid so low, and working for the government, that they are entitled to state assistance benefits.
Hang on a moment, this appears to be comparing total management costs in the NHS with management costs within hospitals in the USA and Canada, leaving out all the management costs of insurance companies (not to mention the government bureaucrats involved in regulation and the like). Is that what you intended? If so, that makes the U.S. system a great deal worse in this regard than a casual glance at your figures would suggest (which themselves are plenty bad enough!).
I can’t help but notice that these statistics omit over 700,000 employees of the NHS. Although some of them are certainly lab technicians and orderlies and other people with a direct contribution to patient care, I can’t help but suspect that a substantial portion are administrative staff.
I often find that reading this kind of document, that it is more useful to note the information that is omitted, rather than what is disclosed. It is often necessary to parse what they say very carefully to figure what they are actually saying and what they are implying.
I’m also curious about what percentage of the doctor and nurses time is spent on administrative duties and how much on patient care. I read a recent article by Theodore Dalrymple, that said the actual output of the NHS has decreased by 4% while the spending has increased 60%.