INTERNATIONAL PERSPECTIVES FORUM Universal Health Care Lessons From the British Experienc.pdf

January 2003, Vol 93, No. 1 | American Journal of Public Health Light | Peer Reviewed | International Perspectives Forum | 25 ? INTERNATIONAL PERSPECTIVES FORUM ? Policy Dilemmas Facing Any Health Care System On the basis of the writings of Rudolf Klein4 and my own ex- periences, there are 7 policy dilemmas that the NHS has faced since its founding. They also challenge any large health care delivery system, such as Kaiser Permanente or Aetna-US Health Care in the United States, though often they are simply avoided. 1. How does one reconcile the need for regional or national coordination with the ability to respond to local needs? 2. How does one reconcile urban with rural needs and the problems of maldistribution? 3. How does one devise a national health care system and yet honor and foster the energies, creativity, and resources of the voluntary sector? 4. How does one reconcile public accountability with profes- sional autonomy and expertise? 5. How shall primary care be integrated with specialty and hospital care? 6. How shall individualistic principles and patterns of practice be reconciled with national standards and a national system? 7. How is a system to reconcile a focus on the patient with a focus on community and population health? Universal Health Care: Lessons From the British Experience | Donald W. Light, PhDBritain’s National Health Service (NHS) was established in the wake of World War II amid a broad consensus that health care should be made available to all. Yet the British only barely succeeded in over- coming professional opposi- tion to form the NHS out of the prewar mixture of limited na- tional insurance, various vol- untary insurance schemes, charity care, and public health services. Success stemmed from ex- traordinary leadership, a par- liamentary system of govern- ment that gives the winning party great control, and a will- ingness to make major con- cessions to key stakeholders. As one of the basic models emulated worldwide, the NHS—in b