Table Of ContentIn Search of the Perfect
Health System
In Search of the
Perfect Health
System
Mark Britnell
© Mark Britnell 2015
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First published 2015 by
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For Reuben and Beatrix Britnell
'The world is a book and he who does not travel reads only one page'
St Augustine
vii
Contents
Foreword from Lord Nigel Crisp IX
Preface X
The Perfect Health System
Country profiles
Part 1: Asia and Australia 14
2 Japan - Live long and prosper 15
3 South Korea-National pride and global ambition 20
4 China-Communist chimera? 25
5 Hong Kong-Demography, democracy and destiny 31
6 Malaysia- Reform some time, soon? 36
7 Singapore- Wealth and health 41
8 Indonesia-Largest single payer in the world 46
9 Australia-Advance Australia Fair 52
10 India- One country, two worlds 58
Part 2: Middle East and Africa 63
11 Qatar-Build and they will come 64
12 Israel- The best kept secret in global health? 69
13 South Africa-No more false dawns 74
Part 3: Europe 80
14 Russia-A distressed and distressing system 81
15 The Nordics-Decentralised welfare utopia? 86
16 The Netherlands-Competition and social solidarity 92
17 Germany-Doctor knows best 97
18 Switzerland-You get what you pay for 102
19 Italy-No longer 'Ia dolce vita' 106
20 Portugal- The price of austerity 111
21 France-Neither Beveridge nor Bismarck but the Republic 116
22 England-The NHS. In place of fear 121
Part 4: The Americas 129
23 Canada-At the crossroads 130
24 The US-Let's face the music and dance 136
viii Contents
25 Mexico-Unfinished business 143
26 Brazil-Order and progress? 148
Part 5: Global Challenges 153
27 Universal Healthcare-Triumph of political will 154
28 Same Problem. Different Country-The paradox of change 163
29 Clinical Quality-The more I know. the less I sleep 170
30 Value Walks-There is no health care without the workforce 178
31 Patients As Partners-Renewable energy 186
32 Climate Change and Sustainability-Our dirty little secret 194
33 Ageing-Every cloud has a silver lining 202
Part 6: Conclusion 210
34 Conclusion-We wouldn't start from here 211
Key Statistics at a Glance 224
Index 226
ix
Fa reward from
Lord Nigel Crisp
This book is a masterclass in brief and insightful commentary. If you have ever
wondered what was distinctive about healthcare in Asia and the US, what sort of
systems the advancing economies of Brazil and Mexico are developing, or how
continental European systems differed from the UK and Scandinavia, this book
will offer you a short summary of the facts, enlivened with the personal obser
vations of the author. Like all foreign travel this book opens your eyes to new
possibilities.
Mark Britnell has filled an important gap here. His unique experience in the
public and private sectors, as a payer and a provider, and his great success in
leading local, regional, national and global organisations gives his assessments
and opinions particular weight and authority. People from different backgrounds
will find this book fascinating for the way it illuminates the nature and complex
ity of healthcare. He shows that healthcare is a social and cultural construct: the
health system of a country is a product of history, politics and culture quite as
much as it is of science, education and resources. Changing or reforming the
health system is therefore as much a social and cultural movement as a business
and management challenge. You can't just transport a system from one place to
another-but we can all learn from each other.
I have written elsewhere about what we can learn from the poorest countries,
and this is represented here by the description of 'jugaad' innovation in India.
However, it is the descriptions of countries in the East such as Hong Kong, Japan,
South Korea and Singapore that are most intriguing to Western eyes. Their mod
els have led to astonishing improvements: South Korea, for example, imple
mented universal healthcare in just 12 years and life expectancy has shot up
to European levels. These countries are now, however, encountering the health
problems of age and affluence. We can all surely learn from their experience and
from how they mobilise to take on these new challenges. We can also, sadly,
learn from the Russian experience described here in bleak but realistic terms.
Mark Britnell has all the heart and passion of a healthcare professional combined
with the head of a man who leads a successful global enterprise. He infuses the
book with his own humanity and offers insights forged through experience.
Therefore we should all listen when he calls for collective action to tackle the
challenges of healthcare and draws attention to the way other industries have
collaborated in information technology, communications and much else to
develop new and better services. It is a timely and important challenge to us all,
and one we must rise to if healthcare is to become sustainable.
