TY - JOUR T1 - The future of national health systems JF - British Journal of General Practice JO - Br J Gen Pract SP - 319 LP - 320 DO - 10.3399/bjgp11X572292 VL - 61 IS - 586 AU - Iona Heath AU - Dee Mangin AU - Les Toop AU - John Brodersen Y1 - 2011/05/01 UR - http://bjgp.org/content/61/586/319.abstract N2 - Comprehensive national health systems providing universal access, based on social solidarity and funded through social insurance or general taxation, have been one of the major achievements of many countries in the period following the Second World War. Yet everywhere these systems are now under threat. Costs are increasing because of rapid developments in health care technologies, many of which are very expensive, at least initially, and because of ageing of the population which has occurred at least in part because of the very healthcare systems now threatened by their own success.Elected representatives are telling citizens that national health systems are becoming unaffordable, and many are attempting to persuade their electorate that the only solution is a greater or lesser degree of commercialisation and privatisation. This is perplexing when there is much accumulating evidence that heavily privatised systems, most powerfully illustrated by the situation in the United States, produce poorer health outcomes at greater cost and with worse health inequalities.1 Market competition legitimises the pursuit of private profit and also the pursuit of individual advantage at the expense of others. Patients are no longer citizens bound by ties of mutual responsibility, but consumers out for the best bargain. ‘Quality’ is framed as customer satisfaction and the scope of choice, and actively distanced from the reality of care.2Other much more insidious factors inflate healthcare costs to an extent which is difficult to measure but which is almost certainly more threatening and more difficult … ER -