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Finance

The majority of healthcare in the United Kingdom (UK) is delivered by the National Health Service (NHS).  The NHS is a model of universal healthcare based upon the premise of care being free at the point of access.  It is a pooled risk insurance model where funding is collected through taxation.  Taxation is allocated to respective Departments of Health for England, Scotland, Wales, and Northern Ireland, who work to address healthcare priorities.  In 2017, the UK spent $3943 per capita on healthcare.

The private healthcare market in the UK is comparatively small.  It is serviced by four large health insurers and a number of smaller insurers who provide coverage to around 10.5% of the UK population.  Private insurers are financed by subscription payments from their members who can be individuals or organisations.  Healthcare consumers are also able to purchase care directly from providers.

NHS prescription costs, dentistry, and optical care are part of a co-payment system.  However, these services are free to patients if they have certain medical conditions or meet certain financial criteria.

In 2017, the average out of pocket healthcare spending per capita in the UK was $629.  The majority of out of pocket expense on healthcare in the UK is on social care.

Labour

The majority of the UK healthcare workforce is employed in the NHS which is one of the world’s largest employers with 1.5 million employees.  Whilst the majority of NHS healthcare providers are state-owned, some are private contractors.  Due to being state-owned and state funding, wages and benefits of NHS employees are determined by organisations who are accountable to the Government.  Similarly, workforce education and development are subsidised by and heavily influenced by the state in cooperation with key stakeholders such as Professional Registration Bodies and Unions.

NHS employees are often the same individuals who provide services within the private sector.

Access to specialised care in the NHS is via a GP referral.

Access to specialised care in the private sector is usually by self-referral or insurer triage.

 

Technology

The UK is a collection of technologically advanced countries where the utilisation of technology is world-class.  For example, 99% of Primary Care clinicians have access to and utilise an electronic patient healthcare record.

A limiting factor in accessing technology in the UK is the need to account for cost effectiveness in the NHS.  In a state insurance-based system where resources are limited and openly scrutinised, the Government is frequently called upon to explain their decisions.  In 1999, this lead to the development of the National Institute for Health and Clinical Excellence (NICE) which was created to end rationing of treatment based upon geography.  NICE is seen as a world leader in the appraisal of treatments and medicines for use in healthcare including assessments of clinical value and cost-effectiveness.

References

https://www.nhs.uk/conditions/social-care-and-support-guide/money-work-and-benefits/paying-for-your-own-care-self-funding/

https://www.commonwealthfund.org/international-health-policy-center/countries/england

https://www.nuffieldtrust.org.uk/chart/the-nhs-is-one-of-the-world-s-largest-employers

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