I agree with Christian Vassie and his letter of January 18 with changing the funding system of the NHS to that of European style social insurance, compulsory with contributions income-related.

There was an opportunity to introduce comprehensive health insurance in 1919, but it was not to be.

This was a disaster for the voluntary hospitals, the infirmaries, many of which became bankrupt. Inevitable nationalisation of the health services came into being in 1948, with great optimism and immediate approval.

Unfortunately the optimism was not to last. The first financial crisis resulted in the introduction of prescription charges in 1952, and subsequently many reorganisations.

Waiting lists have remained a characteristic of the NHS. The government decides the annual funding of the NHS, then there is a large and unproductive bureaucracy that decides how, where and what health care should take place.

With an insurance base the health care providers, general practice and hospitals, would have no prospective funding, but would be paid on the basis of work done, like other organisations. A patient would thereby become an asset rather that a nuisance.

A great saving would be made in removal of the very large bureaucracy that distributes funds within the NHS, but the savings would be offset to a certain extent by the creation or expansion of health insurance organisations.

We might be able to change to continental-style insurance based health care and we would see great improvements. UK citizens in France for example report a greatly improved access to high quality heath services.

However although things are bad in the NHS, the change from a nationalised state funded system to denationalised insurance might be too disruptive.

Government would lose control of health funding and this would be politically unattractive to say the least.

I suspect that we will just continue to muddle through as before.

Dr David S Grimes