Sir: You were correct to point out that 'the United
States spends more than four times as much per head on health as Great Britain, and Germany twice as much, yet their statistical indicators of health are, if anything, slightly worse' (Leading article, 4 May). However, you did not follow this striking observation any further.
If you had done so you would have found that about half of the difference in both cases was due to the higher level of cost of provision in those countries (far more than could be justified by differences in the general price level or even the impact of higher levels of real incomes on the cost of labour-intensive services). The other half was due to a genuinely higher level of provision.
This leads to two intriguing possibilities. First, is it not possible that the existing level of health provision in the United Kingdom might be close to adequate; no doubt capable of modest improvement but not requiring any radical change? Second, is it not possible that the United Kingdom system of public funding and public provi- sion of health care is a relatively low-cost system by international standards; again by no means incapable of further improve- ment but not requiring drastic upheaval?
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