Question 4 of the 2011 RES essay competition is this: ““An NHS free at point of access is unsustainable in the 21st century and an alternative funding model is needed.” Discuss.

I really like this question! The economics of how best to fund health care in the United Kingdom is hugely important and the question invites an ambitious approach which gets to the heart of the
sustainability of one of the central pillars of the NHS in the UK and alternative approaches. It raises key questions about access to health care, equity, efficiency and the challenges of meeting the growing demand for health care services in the near future and over the longer term.

Strong answers will address the issue of sustainability head-on. And they will be clear about how health care in the UK is funded at present and the arguments for and against the current and alternative funding models.The best answers will avoid an overly-theoretical approach and have a good base of empirical evidence drawing from both the UK and other countries. Making value judgements is inescapable in this sort of essay - the judges will expect students to state their views clearly at the end - but on the basis of their assessment of the data and the issues. The best answers will have escaped from a narrow AS-microeconomics approach and will have explored some of the literature on this topic.

Suggestions for extension reading

About the NHS - introductory statistics

British Medical Association: Healthcare policy resources (including Healthcare funding)

BBC news articles on health

Guardian articles about the NHS

Nuffield Trust

British Medical Journal - articles on health economics

NHS Confederation

McKinsey report on the fiscal future of the NHS (2009)

Health Service Journal - articles on NHS funding and NHS reform

Does the NHS have a future? (BBC 2008)

Health news stories from the Independent

UK Department of Health: Equity and excellence: Liberating the NHS (White Paper, July 2010)






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