Letter: NHS on critical list

Sir: Again we have a crisis in the

Sir: It is amazing to find, in your leading article "Here comes the winter health crisis" (Review, 28 October), the fatuous state- ment that "Britain spends far less on health care than France or the USA".

To be sure, we do. Perhaps you think it would be an improvement if we had a predominantly private-insurance-based system like that of the USA, with the number of operations such as hysterectomy that are performed - several times higher than in Britain, per thousand of population - with a fee-driven system providing some part of the explanation? And the running costs, and the necessary profits, of insurance agents, adding to the costs?

Or a system with the features of the French system, with virtually none of the deterrents of excessive prescribing that exist in the NHS, so that the number of prescriptions per head of population is way above that of Britain? And where there are none of the rules requiring doctors to prescribe only generic drugs where at all possible, so that in France your prescribed medicine comes to you virtually gift-wrapped?

Have you any idea how much money goes into commercial companies in France, as a result, compared with Britain?

All these factors inflate the amount "spent on health care". Do you really think they are a good thing none the less?

While the British NHS has its faults, at least it spends a higher proportion of its total expenditure on patient care than virtually any other comparable system.

J M SMITH

West Kirby,

Merseyside