What can Americans Learn from the UK’s National Health Service?

A graphic entitled U.S. Health Care Ranks Last Among Wealthy Nations summarizing a study by The Commonwealth Fund caught my eye recently. It compared 11 developed nations on health care quality, access, efficiency, equity, and various patient outcome measures.  Although the the fact that the United States was last in health care caught my eye (we Americans, after all, do not like to be last in anything), I found myself thinking about the nation that was first in the rankings–The United Kingdom.  As Americans, we have been taught that the “socialized” medicine in places like the United Kingdom was bad and here it was in first place.  My curiosity was piqued.  What is so great about the United Kingdom’s National Health Service (NHS) and can we Americans learn a thing or two from them?

While the United Kingdom’s National Health Service structure is totally different from our private healthcare system, there are many lessons in cost containment and quality of care improvement we can apply.  The UK’s per person health care costs are less than HALF that of ours ($3405 in the United Kingdom and $8508 in the United States in 2011) and their quality of care is better than ours.  This “socialized” healthcare system must be doing something right!

As I read the principles and values that govern the NHS, I was struck by the central idea that patients come first and that “working together for patients” is at the heart of healthcare service.  Healthcare websites based in the United Kingdom (NHS and others) are patient-centered and geared to making patients “engage” in their own health care. Healthcare websites based in the United States are never patient-centered and rarely as patient-friendly as those in the United Kingdom,

When reading this post about the United Kingdom’s National Health Service (NHS), please leave preconceived notions of “socialized medicine” at the door and think for yourself  based on the data and not on fear-mongering, profit-motivated jibberish.  The brief description below is geared to  give members of BB’s brigade some healthcare reform ideas to ponder.  Our healthcare system desperately needs as much “out-of-the-box” thinking it can gather before Affordable Health Care and Beyond for All Americans can be achieved.

National Health Service

Introduction to United Kingdom’s National Health Service (NHS)

Each of the four countries that make up the United Kingdom (England, Scotland, Wales, and Northern Ireland) are part of the United Kingdom’s National Health Service (NHS), but each country independently runs and is accountable for the NHS within its borders. The UK’s National Health Service is a single-payer healthcare system and is 98.8% funded out of general tax revenues and national insurance (the remaining 1.2% comes from patient charges). All medical personnel are salaried and hospitals are publicly owned. In the United States, our healthcare system is funded and administered from many sources (both private and public).

The National Health Service provides a well-defined package of health care services to everyone who is a permanent resident of the UK (making the health care universal). In the United States, not all permanent residents are covered–those not quite poor enough to qualify for public coverage and those too poor to afford subsidized, private health insurance.  The National Health Service is not strictly an insurance system because (a) there are no premiums collected, (b) costs are not charged when the patient seeks medical care, and (c) costs are not pre-paid from a communal pot. However, it does achieve the main aim of insurance which is to spread financial risk arising from ill health.

Private health care and private health insurance does exist in the UK and runs alongside the National Health Service (NHS). It is generally used as a supplement to (and not a replacement for) NHS care.  Less than 8% of the population use private health care.

As a single-payer system, administrative costs are a fraction of what Americans pay through our fragmented system of private and public health insurance plans. The government negotiates with drug and medical product companies for reduced prices for all its beneficiaries. In the figure below, a comparison of the average drug prices (2013) tells the story of how large group negotiating power benefits UK residents more than Americans.  In the United States, our government is actually barred by law from negotiating for better drug prices for our largest group of beneficiaries (Medicare recipients).

England-United States-Drug-Price-ComparisonPermanent residents of the UK can access the full breadth of critical and non-critical medical care without any out-of-pocket payments (except for small copays for eye tests, dental care, prescriptions, and aspects of long-term care). However, these charges are often waived for the most vulnerable (the elderly, children, disabled) or low income groups. Under the National Health Service (NHS), a person would never be put in a situation where high medical bills could result in medical bankruptcy, or having to choose between eating, keeping a roof over his head, or paying unreimbursed medical expenses.

Ten years before the HiTech Act of 2009  legislated “voluntary” electronic health records in the USA, the National Health Service (NHS) was embracing digital technology for health care data sharing and communication.  Over the subsequent years of advancing and changing technology, this Health Information Technology (HIT) function has experienced many growing pains and the history of its utilization has many lessons for the USA.

Use of Evidence-based Medicine for Best Practice Guidelines

The UK’s healthcare system differs from ours in another fundamental way; namely, in the use of “best practices” guidelines.  The National Institute for Health and Care Excellence (NICE) at the National Health Service (NHS) collects and uses evidence-based clinical health care data for delivery of the latest medical care to all residents in its system.

The NHS takes the data and defines “best practices” guidelines that all medical providers must take fully into account as the foundation for treatment.  The NHS doctors take the guidelines along with the individual needs, preferences and values of their patients.

These guidelines are continuously updated and are available for all to see.  It is interesting to compare how the United States and the United Kingdom treat “best practices” guidelines.  Visit the websites (click on the country links) and judge for yourself.   In the United States, medical professionals, operating as private businesses, are not required to take “best practices” guidelines as the foundation for treatment and are free to treat patients in a less than “best” way (in the United States, this usually means in a more costly and dubiously “better” way).

Can these “best practices” guidelines in the UK be tweaked (and enlarged?) for the United States?  Must we spend money to collect our OWN data or can be use the British data as a foundation? Who knows, the Brits may have a few ideas that we Americans can use without having to reinvent the wheel at home. They might have a lesson or two about how to save some healthcare dollars!

People First– Not Profits

In 2012, the NHS had a revamp and strengthened two areas that I feel are positioning them for even better results; namely,

  1. Putting into law patient-engagement across the entire health care system–both on personal and on national levels where health care policy and decisions are being made.
  2. Recognizing that health care quality and efficiency entails both medical and social interventions. For example, keeping the elderly in their homes through social programs is more cost-effective than warehousing them in medically-staffed institutions.
  3. Having a central organization that collects, analyzes and presents national health and social care data for cost-benefit evaluation will greatly improve future quality of outcomes for ALL.
  4. Decentralizing medical care by giving greater autonomy to community general practictioner-led groups to provide the best care for their patients locally.

The Bottom Line

As a taxpayer and patient, I find many of the above aspects of the United Kingdom’s National Health Service worthwhile.  One cannot ignore the fact that their healthcare system cost less than half of ours and delivers better quality! Is it perfect?  Of course, not. It is constantly improving and changing to meet the needs of its residents and not the needs of for-profit healthcare businesses.

As members of BB’s Brigade, we must keep our minds open to all health care reform ideas that are available for consideration in our mission for Affordable Health Care and Beyond for ALL Americans.


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