Healthcare in The United Kingdom

Summary

The UK's National Health Service (NHS) offers comprehensive healthcare coverage to all residents, including preventive, inpatient, outpatient, and long-term care, with minimal out-of-pocket costs. Funded largely by general and payroll taxes, the NHS is efficient, spending only 9.4% of GDP on healthcare compared to the US's 17.7%. However, to maintain low costs, the NHS faces challenges such as limited drug availability, less advanced technology, and longer waiting times.

Takeaways

• 🏥 The UK's National Health Service (NHS) provides comprehensive healthcare coverage to all residents, including preventive, inpatient, outpatient, dental, mental health, and long-term care.
• 💊 Most healthcare services are free at the point of use for citizens, with minor exceptions like co-pays for outpatient drugs and some dental services.
• 👶 Certain groups, such as children, the elderly, and those with chronic conditions, are exempt from co-pays, leading to low out-of-pocket costs for the majority.
• 💼 Public expenditures cover over 80% of healthcare spending, primarily funded through general taxes and a payroll tax.
• 💼 Approximately 10-11% of the population has private supplemental insurance, often as part of an employer-based benefit system.
• 👩‍⚕️ General practitioners (GPs) and specialists are salaried and work under a national contract with the government, with payments including capitation and performance bonuses.
• 🏢 Publicly owned hospitals are run by NHS trusts and reimbursed based on diagnosis-related group (DRG) rates, with some services also purchased through the private sector.
• 🏡 Long-term care is primarily funded by the private sector, but the NHS provides free state-funded residential care for those earning less than £23,250.
• 💰 The UK spends significantly less on healthcare as a percentage of GDP compared to the OECD average and the United States, achieving more with fewer resources.
• 👩‍⚕️ Despite lower spending, the UK has a higher number of physicians per capita than the OECD average and better health outcomes in terms of life expectancy and mortality rates.
• 🚑 The NHS faces challenges such as limited availability of certain drugs, less prevalent technology, and longer waiting times, which are areas of ongoing improvement.

Q & A

What is the National Health Service (NHS) of England?

The NHS is a government-run healthcare system that provides care to everyone, including a wide range of services such as preventive, inpatient, outpatient, dental, mental health, and long-term care.

Who is covered by the NHS?

The NHS covers everyone who is ordinarily resident in the UK, which includes citizens, residents, and even visitors and illegal immigrants for emergency care and certain infectious diseases.

Are there any costs associated with NHS services?

Most services are free to citizens once they've paid taxes. Exceptions include dentistry and outpatient drugs which have a co-pay, but even these have exemptions for certain groups.

What is the financial burden on patients in England due to the NHS?

Out-of-pocket costs are very low, with only 6% of prescriptions incurring the full co-pay. Public expenditures cover over 80% of all healthcare spending.

How does the NHS fund its operations?

About three-quarters of NHS funding comes from general taxes, and most of the rest from a payroll tax. Private expenditures cover over-the-counter drugs and other medical products.

What is the role of general practitioners (GPs) in the NHS?

GPs deliver the majority of primary care and work under a national contract with the government, being paid through a mix of capitation, fee-for-service, and bonuses for good performance.

How does the NHS manage its hospitals and specialists?

Specialists are salaried and work for the government. Hospitals are run by NHS trusts and paid for care at nationally negotiated rates. Some specialists also treat private patients.

What is the cost of healthcare as a percentage of GDP in England?

In 2011, England spent about 9.4% of its GDP on healthcare, which is significantly lower than the OECD average of 9.9% and the United States' 17.7%.

How does England's healthcare expenditure compare to the United States on a per person basis?

England spends $3,455 per person on healthcare, which is about 40% of the more than $8,500 spent per person in the US.

What are some of the potential downsides of the NHS system?

To keep costs low, the NHS may limit access to certain drugs and technologies, have fewer hospital beds, and longer waiting times compared to other countries.

How do the British people feel about the NHS?

The British people generally love their healthcare system and support it, including through repeated elections, despite acknowledging its shortcomings.

Outlines

00:00

🏥 Overview of the UK's National Health Service

The National Health Service (NHS) of England provides comprehensive healthcare coverage to all residents, including preventive, inpatient, outpatient, dental, mental health, and long-term care. The system is largely funded by taxes, with minimal out-of-pocket costs for citizens. Despite covering a broad range of services, the NHS operates efficiently, with healthcare expenditures constituting only 9.4% of GDP, significantly lower than the US's 17.7%. The NHS also boasts better health outcomes compared to the average, such as lower infant mortality rates and higher life expectancy.

05:01

🚑 Challenges and Trade-offs of the NHS

While the NHS is efficient and cost-effective, it faces challenges such as limited availability of certain drugs, less advanced technology, and a scarcity of hospital beds compared to the US. Staffing levels are high, leading to potential overcrowding and compromised comfort in hospitals. Patient wait times can be longer, and the UK's healthcare quality metrics are not as high as desired. However, the British public strongly supports the NHS, indicating satisfaction with the trade-offs for the financial benefits it provides.

Keywords

💡National Health Service (NHS)

The National Health Service (NHS) is the publicly funded healthcare system in England. It is central to the video's theme as it provides comprehensive healthcare coverage to all residents, including preventive, inpatient, outpatient, and long-term care. The NHS is a government-run system, which is a key point of discussion in the video, highlighting how it operates and the services it offers.

💡Socialized Healthcare

Socialized Healthcare refers to a system where healthcare services are provided by the government and funded through taxes. The video discusses socialized healthcare as a concept and contrasts it with other systems like those in the United States and Canada. The NHS is presented as an example of a socialized healthcare system.

💡Co-Pay

A co-pay is a fixed amount that patients pay out-of-pocket for a healthcare service, in addition to what is covered by insurance. The script mentions that the NHS has a co-pay for outpatient drugs, which is a small part of the overall healthcare costs that patients might incur, illustrating the extent of coverage provided by the NHS.

💡Capitated Services

Capitated Services refer to a payment model where healthcare providers are paid a fixed amount per patient, regardless of the number of services provided. The video explains that most general practitioners (GPs) in the UK work under a national contract with the government and are paid through capitated services, which is a key aspect of how the NHS manages costs.

💡Out-of-Pocket Costs

Out-of-pocket costs are the expenses that patients pay directly for healthcare services. The video emphasizes that out-of-pocket costs in England are very low due to the NHS, with only a small percentage of prescriptions incurring the full co-pay, showcasing the affordability of healthcare in the UK.

💡GPs (General Practitioners)

General Practitioners, or GPs, are the primary care physicians who provide the first point of contact for patients in the NHS. The video discusses how patients are required to register with GPs, who then deliver the majority of primary care services, highlighting the role of GPs in the UK healthcare system.

💡Payroll Tax

A payroll tax is a tax that is deducted from an employee's wages and is used to fund social programs like healthcare. The video mentions that a portion of the NHS's funding comes from a payroll tax, which is one of the mechanisms through which the UK government finances its healthcare system.

💡Private Supplemental Insurance

Private Supplemental Insurance refers to additional health insurance coverage that individuals can purchase to supplement public healthcare coverage. The video notes that about 10% to 11% of the UK population has private supplemental insurance, which is used for elective procedures and other services not fully covered by the NHS.

💡Long-term Care

Long-term care refers to a wide range of services and support for individuals who have chronic health conditions or disabilities. The script explains that the NHS pays for long-term care, although less so than in the past, and that those with incomes below a certain threshold are entitled to free state-funded residential care.

💡Healthcare Expenditure

Healthcare Expenditure refers to the total amount of money spent on healthcare services. The video compares the UK's healthcare expenditure as a percentage of GDP to that of other countries, emphasizing the efficiency of the NHS in providing comprehensive care at a lower cost.

💡Quality of Care

Quality of Care refers to the standard of healthcare services provided. The video acknowledges that while the NHS is efficient, it may not always provide the highest quality of care, as indicated by certain metrics. It also mentions efforts to improve quality, such as increasing patient choice and enhancing transparency and accountability.

Highlights

The National Health Service (NHS) in England provides care to everyone, covering a wide range of healthcare services.

The NHS system covers everyone ordinarily resident in the country, except visitors and illegal immigrants.

Even visitors and illegal immigrants can receive free care in emergency departments and for certain infectious diseases.

Healthcare services covered by the NHS include preventive, inpatient, outpatient, dental, mental health, and long-term care.

Citizens pay almost no cost-sharing for most services, with exceptions for dentistry and outpatient drugs.

Outpatient drugs have a co-pay of just over £7.2, while inpatient drugs remain free.

Certain groups are exempt from outpatient drug co-pays, including children, the elderly, and those with chronic diseases.

Only 6% of prescriptions incur the full co-pay in England, indicating very low out-of-pocket costs.

Public expenditures cover more than 80% of all healthcare spending, primarily funded by general taxes and a payroll tax.

About 10-11% of the population has private supplemental insurance, often part of an employer-based benefit system.

General practitioners (GPs) work under a national contract with the government and are paid through a mix of capitation and fee-for-service.

Patients have increased ability to choose hospitals and specialists compared to the past.

Publicly owned hospitals are run by NHS trusts and paid for care at nationally negotiated rates.

The NHS pays for long-term care, though less than in the past, with free state-funded residential care for those earning less than £23,250.

England spent about 9.4% of GDP on healthcare in 2011, compared to the OECD average of 9.9% and the US at 17.7%.

The NHS is praised for its efficiency, spending only 40% of what the US spends per person on healthcare.

Despite lower spending, the UK has better than average life expectancy, cardiovascular disease mortality, and cancer mortality rates.

The NHS faces challenges such as limited availability of drugs, less prevalent technology, and longer waiting times.

The British public continually supports the NHS, indicating satisfaction with their healthcare system despite its shortcomings.

The NHS demonstrates the trade-offs between cost and quality in healthcare systems, emphasizing the financial benefits of a socialized system.

Transcripts

we've done the United States Canada and

France none of them are really

socialized Healthcare Systems to get at

that we need to go look at a system like

that of the UK more specifically the

National Health Service of England is

the topic of this week's Healthcare

triage people like to throw around

government Run Healthcare as a phrase

most of the time it's a little

hyperbolic but in the case of England

it's actually pretty accurate the

National Health Service there provides

care to everyone all kinds of care the

system covers everyone who's ordinarily

resident in the country basically that

means everyone except visitors and

illegal immigrants but even those groups

can receive free care and emergency

departments and for certain infectious

diseases coverage is pretty broad

preventive Services inpatient care

outpatient care physicians drugs Dental

Care Mental Health Care paliative Care

Rehabilitation long-term care even some

eye care it's all covered and it's

pretty much free to Citizens once

they've paid taxes almost everything I

mentioned just a few seconds ago has no

cost sharing whatsoever with the

exception of dentistry and outpatient

drugs the latter have a co-pay of just

over 7.2 pound impatient drugs on the

other hand are still free and there are

groups that are exempt even from

outpatient drug co-pays kids under 16 no

co-pays kids 16 to 18 who are still

still in school no co-pays if you're 60

or older poor pregnant have had a baby

in the last year or have a number of

chronic diseases no co-pays it turns out

that only 6% of prescriptions actually

incur the full co-pay in England so

outof pocket costs in England are really

really low public expenditures cover

more than 80% of all Healthcare spending

about 3/4 of that comes from General

taxes and most of the rest from a

payroll tax over-the-counter drugs and

other Medical Products account for

another 10% or so of spending the is

mostly Private Hospital care for

elective procedures a lot of this is

covered by voluntary health insurance

most of it part of an employer-based

benefit system so basically about 10 to

11% of the population has private

supplemental insurance two private

insurers cover about 2third of all of

those people people are required to

register with general practitioners who

deliver the vast majority of primary

care most GPS work under a national

contract with the government and are

paid through capitated Services a bid of

fee for service and bonus for good

performance but unlike most other

countries GPS actually work for the

government as do Specialists almost all

of them are salar at hospitals run by

the NHS patients have more of an ability

to choose not only which hospitals

they'd like to go to but also which

Specialists they'd like to see in those

hospitals than they have in the past

about half of Specialists treat some

private patients in private hospitals as

well publicly owned hospitals are run by

NHS trusts they're paid for Care at

nationally negotiated diagnosis Related

Group group rates or drg rates some care

is purchased through the private sector

especially for mental health and

elective care finally the NHS pays for

long-term care although less today than

it used to those who make less than

£23,250 are entitled to free state

funded Residential Care most Residential

Care is paid for by the private sector

though endof Life paliative Care however

is provided by the NHS in hospices homes

or even hospitals what's great about the

NHS it's cheap in 2011 England spent

about 9.4% of GDP on Healthcare compared

to the oecd average of 99.3% and the

United States

17.7% they spent

$345 on Health Care per person which is

just above the oecd average but that

$3,455 is only 40% of the more than

$8500 per person spent in the US the

number of Physicians per 1,000

population at 2.8 is lower than the oecd

average of 3.2 but above the United

States 2.5 which means they have more

doctors than we do they produce higher

than average numbers of medical

graduates as well life expectancy at

Birth is 81.1 years above the oecd

average mortality from cardiovascular

disease is similarly better than average

cancer mortality is below average though

it's worth acknowledging there have been

better than average improvements in the

last decade or so infant mortality rates

are low as are suicide rates diabetes

prevalence is low in spite of the

English diet the percentage of adults

who report being in good health is well

above average and they do this on a Sho

string imagine if we in the United

States spend 40% of what we do right now

on Healthcare we'd have an extra like

1.6 trillion dollars or more to play

around with we could massively increase

spending on tons of other programs and

still have a surplus there are downsides

in order to keep spending so low the NHS

makes certain decisions other countries

might find unpalatable some drugs are

unavailable technology is nowhere near

as prevalent as in other countries

hospital beds are even scarcer than in

the United States Physicians and nurses

work pretty hard hospitals aren't geared

towards personal comfort and can be

overcrowded underst staffed and

sometimes even dirty from what I hear

waiting times can be longer than in

other countries and on many metrics of

quality the UK Falls below where they

would like to be they're working to try

to fix some of this they've tried to

increase patients abilities to make

choices provide ERS are given more

incentives to improve quality

transparency and accountability are

increasing but as with almost all of

these episodes it's important to

remember that Britain is a free and

Democratic Nation they chose the NHS and

they do so again and again they love

their Healthcare System and even elected

officials from the conservative party

support it there are tradeoffs to Health

Care Systems as there are with so many

things in medicine it's easy to demonize

socialized medicine for its shortcomings

we can't ignore its Financial benefits

though the NHS may not always be the

best but it certainly can lay claim to

being efficient