Review

Why pay more?

Public-Private Relations in Health Care
Justin Keen, Donald Light and Nicholas Mays
Kings Fund, 2001. £14.99

This book provides useful information and analysis of the relationships between public and private healthcare, with a focus on the UK, the US, Ireland and the Netherlands. It is easy to understand and reasonably comprehensive, dealing with a wide variety of private health care including dentistry, non-prescribed medication and private medicine.

Information about private healthcare and insurance is not easy to come by, and I, for one, had not appreciated the significant differences between the working of health insurance in the UK and the situation in other countries. Health insurance in the UK is far less regulated than in the countries where it is central to the provision of healthcare.

Nonetheless, insurance in both the UK and the US is characterised by unscrupulous behaviour made possible by the complexity of the product and the lack of information available to the consumer. An insurer who accepts bad risks will quickly enter the ‘cycle of death’ where all such risks are unloaded by the competition, forcing them to raise premiums – driving away the good risks.

The authors make a number of worthwhile recommendations to make private health insurance more equitable. Governments of all political complexions have ignored the very obvious problems for too long. It doesn’t take much analysis to see that insuring the entire population against the risk of healthcare costs is a much more efficient and effective way of paying, but there is no reason why those who do choose to pay privately should be ripped off.