The NHS as an insurer.

The National Health Service (NHS) in England is not only a commissioner and provider of health care to the sick, but also offers certainty and peace of mind to all citizens--even those who do not use the health service in any year. However, due to the recent dominance of cost-effectiveness and cost-utility analysis as the central factors determining resource allocation decisions in the NHS, this second role--which we term its 'insurance value'--has increasingly become neglected. In this paper, we argue that this inattention is detrimental to the population at large. We explore some implications to the NHS of maximizing insurance value. These include requiring commissioners to take explicit account of how denial of service undermines peace of mind; requiring the National Institute for Health and Clinical Excellence (NICE) to calculate not just the health benefits, but also the peace of mind benefits of health technologies; and establishing a formal NHS 'insurance regulator' analogous to the Financial Ombudsman Service. Insurance value should be a guiding principle for NHS decision-makers.