Flag of the United Kingdom
In the previous article, we examined the universal, single-payer health care system in Canada, including its positive health outcomes. While enjoying relatively high public approval, the Canadian system is not without its flaws, and current reforms are being undertaken to address them.
Nonetheless, there is much to learn from the single-payer method of health care. This article will explore the British health care system – another single-payer plan – and its relative successes, failures, and efforts at policy reform.
Read: A history of health care in the U.S.
Read: Distortions in the public debate on health care
Read: The Patients’ Choice Act
Read: The Affordable Health Choices Act
Read: The Public Option
Read: The Canadian health care system
Britain/The United Kingdom
The National Health Service Act was established in 1948 on "the principle of collective responsibility by the state for a comprehensive health service, which is to be available to the entire population free at the point of use." British health care is delivered through the National Health Service (NHS), which like Canada is publicly funded through tax contributions and national insurance contributions from employees, employers, individuals, and the government
Like Canada, Britain enjoys better health outcomes than the United States on most key measures – though Canadian’s rate even higher than their British counterparts. Like Canada, the British have not abandoned the premise of collective responsibility with respect to their health care systems, but do recognize existing problems, and are taking action.
According to a report on health care financing in the U.K., England is split into 10 territories, each with a strategic health authority governed by a board consisting of 8 to 13 appointed members – similar to the provincial authorities in Canada. Their primary responsibility is to monitor the public health care services within their respective regions, and to monitor primary care trusts and ensure that they follow government policies.
There are roughly 152 primary care trusts throughout the territories, each governed by a board of 8 to 15 appointed members. They control around 80 percent of the NHS budget, and are responsible for planning and managing health care services in their localities. Most hospitals are publicly-owned in the U.K., while in Canada, they are private, non-profit organizations. For a visual chart of the financial and service flow in the NHS, click here.
Health care resources are distributed to the primary care trusts based on a weighted capitation formula determined by the size of the population and weighted for: age, additional need (based on socioeconomic status), and geographical variations in cost. Similar to Canada, in Britain almost all primary care services are delivered by private physicians fully subsidized by the government. Physicians are also rewarded through a framework that encourages quality care.
While private insurers are not banned or prohibited from offering services in the U.K. - as they are in Canada - they cover mostly duplicative procedures already provided through the NHS, so only 11% of the population even bothers to purchase the supplemental plans offered. Two private insurers serve nearly two-thirds of the market-share for private supplemental insurance.
While the British offer a generous prescription drug benefit, charging a flat fee of about 12 dollars, which exempts the young, elderly, and poor – ultimately dispensing roughly 85 percent free of charge – the Canadians do not have any uniform prescription coverage. Though the provincial plans can – and some do – subsidize the cost of drugs.
Like the Canadians to the north, our Western allies in Europe have managed to provide universal care to Briton’s for decades, and do it while only consuming about 8.4 percent of their GDP (10.1 percent in Canada.) The British system faces the same challenges as the Canadians’: wait times and rising costs. As a result of initiatives mandated at the national level, meeting performance targets for accessibility, and poor financial management, Britain is now beginning to look for efficiencies that can be created within the system, in addition to revenue increases, and reorganizing incentives.
Some reforms that the U.K. has proposed over a ten-year period include demand-side reforms, such as increasing patients' choice (Britons are only able to see NHS doctors); supply-side reforms, involving provider incentives; increasing efficiencies by setting quality standards and monitoring compliance; and transactional reforms that encourage electronic medical billing. The system should also focus on improving accountability through transparency.
Both Canada and Britain are beginning to experiment with, and are considering further reforms involving the free market. By creating appropriate incentives in an effort to meet the growing needs of the population, and using governmental oversight to keep the inherent market failures of the health care industry in check, both systems are grappling with the appropriate balance between the interests involved.
While both have relatively low administrative costs, they both risk stifling innovation and putting off care for unhealthy periods of time due to systematic underperformance, inefficiencies, and limited resource capacity. They both lack elements of competition that could improve their overall performance.
The next article will look at the national health plan in Taiwan, which has not only managed to provide universal coverage, but achieves it through insurance premiums that have resulted in more coverage for the same cost; expenditures that consume less GDP than both Canada and Britain, with virtually no waiting times and in fact, overcapacity.
Read: The health care system of Taiwan
To receive notification when the next article of the series on health care reform is published, click on the “Subscribe” link below.
*If you would like to submit a health care story, with the possibility of seeing it published here, please send me an email message at jennyk1981@gmail.com.
Copyright ©2009 Jenny Kakasuleff
Health Care Financing Policies of Canada, the United Kingdom, and Taiwan
Universal Health Care: Lessons From the British Experience
Is British-Style Health Care the Answer?
Health Care Systems: The Four Basic Models
Five Capitalist Democracies & How They Do It
Comments
I'm really not to fond of the Brit's dental plan though...
Excellent reporting, Jenny. As to Austin Powers ' comment above, I wish I had dental insurance here in the United States.
No gubmint handouts or obamacare for me.
Karen Harper says: "I wish I had dental insurance"
Get a JOB!
Truly impressive reporting. This series shows how out of touch our country is with modern health care. While there is no perfect system, ours is far inferior to the ones presently used by other countries. You also show how the black and white view on this issue which the GOP is pushing is a falsehood.
Karen is part of the group of crybaby whiners who want to be nursed from cradle-to-grave. The pioneers of long ago would find these pukes pathetic.
Well well well, The bigot Raymond Gellner opens his pie hole to pollute with CO2 and little else.
Social Services does not provide Karen Harper with dental?
A group of 100,000 U. S. physicians, members of Sermo, say that the American Medical Association (AMA) endorsement of government-run healthcare does not reflect the views of practicing physicians."
"Sermo recently conducted a survey that spanned 68 specialists in all 50 states whose average age was 49 years of age. These doctors had a median of 13 years experience in practice who work in practices of all sizes in all major urban and remote rural areas across the United States.
Of the 4,165 doctors that participated
* 75% were not members of AMA
* 89% agreed with the claim that AMA does not speak for them
* 91% said that AMA does not accurately reflect their opinions as physician."
industry.bnet.com/healthcare/1000913/who-speaks-for-physicians/?tag=content;col1o
Thanks Martha.
Jenny, why do you REFUSE to answer the question?
Do YOU believe any final plan SHOULD INCLUDE the Executive and Legislative branches of government?
I cannot understand your fear of answering this simple question. I have written to my 3 reps to ask the same question.
Que: Anyone interested in that answer may clearly define it by reading my work. Hence, improve upon your reading comprehension, and do your own homework. Rather than asking me to answer the question, make your own conclusion based on my work.
Anyone else who actually reads my posts could answer that question. Ask Mark if you can't figure it out on your own.
You got her running Que.
Stop the HATERS said: Karen Harper says: "I wish I had dental insurance"
"Get a JOB!"
I have a job, the medical they offer I have to pay 75% of the premium, does not include dental - after basic living expenses not enough
left for anything and I don't buy tobacco or drugs or booze - having a job doesn't infer that you wil have dental insurance - see my name...
Nanny-State said: "Karen is part of the group of crybaby whiners who want to be nursed from cradle-to-grave. The pioneers of long ago would find these pukes pathetic."
Thank you for your enlightening, insightful contribution - not. See my name...
Wah-Wah-Wah oh woe is me. There are no guarantees in life people, I've struggled and I'm sure you have, and it makes you a better, stronger person in the long run. Maybe you leftist shouldn't be so down on religion, it sure helps me when times are bad.
If a 25 year old 300lb woman is too heavy or tired to work we should feel honored in paying for her health care.
Sound like Obama got the hook-up to me playa, yeah FREE health care. That's what I'm talkin' bout girl!
"Jenny says:
Que: Anyone interested in that answer may clearly define it by reading my work. Hence, improve upon your reading comprehension, and do your own homework. Rather than asking me to answer the question, make your own conclusion based on my work.
Anyone else who actually reads my posts could answer that question. Ask Mark if you can't figure it out on your own. "
WOW, instead of a YES or a NO, I get what, 50 words of useless rhetoric and ad hominem attack that said absolutely nothing.
Your fear of the question says more than your answer ever could.
I DID search your series and found nothing at all that would give me an answer. NOTHING.
Mark? What is the one word answer? Do you know?
Just got through listening to Obammy take an hour to answer 11 softball questions. After hearing him stammer and stutter for an hour, I haven't a clue what that Goober said????
When Jenny has no answers she likes to BS and bloviate like her hero Obama.
Ihatestupidpeople says: "I have a job, the medical they offer I have to pay 75% of the premium, does not include dental"
Oh my!!! I just want to know why you don't pay 100% of it! Whats wrong with paying 100% of something ONLY YOU USE?
Damn, come to think of it, your right. I pay 100% of my life insurance and 100% of my car insurance and 100% of my homeowners insurance and 100% of my Umbrella insurance because there are so damn many of your type that DOES NOT WANT TO PAY 100% OF ANYTHING IN YOUR LIVES!
I want YOU to help ME pay for all that insurance I PAY 100% of!
Nanny State believers.
Que: If you have read my articles and still can't determine how I feel about government involvement in our affairs, then you have a reading comprehension problem. Government oversight will be part of health care reform - whether you like it or not.
"ABC News' Jake Tapper and Z. Byron Wolf report:
How is health care reform progressing on Capitol Hill?
Speaker of the House Nancy Pelosi, D-Calif., today insisted everything is smooth sailing with the House bill that would require every American to have health insurance or pay a fine; create a government run health plan to compete with private insurers to drive costs down; and impose an up to 5.4% new tax on top wage-earners.
“I have no question that we have the votes on the floor of the House to pass this legislation,” Pelosi told reporters.
But a leading conservative “Blue Dog” Democrat told ABC News that claim is questionable.
“No, I don’t think they have the votes,” Rep. Mike Ross, D-Ark., said, arguing if that were the case he and the other six Blue Dogs on the House Energy and Commerce Committee who have been holding up the bill in committee would be under far less pressure."
Don't blame the out of power repubs. The dems own it.
Yes or no?
"Ross says the concerns Blue Dogs have about the current House bill being too expensive and not doing enough to contain health care costs are widespread.
“We’re speaking for a silent majority within the Democratic caucus,” he said. “The American people want us to slow down and they want us to get it right.”
And what about on the Senate side?
Sen. Max Baucus, D-Mont., chair of the Senate Finance Committee, was overheard jokingly telling House Majority Leader Steny Hoyer, D-Maryland, “let me tell you, praying might be helpful here.”"
Obama said tonight: "And it's about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid."
But Jenny said it was such an "easy fix".
Maybe Obamacare can help Oprah lose some weight?
Que: We were talking about SS and the obvious solutions; with respect to controlling Medicare/Medicaid, that will all depend on the success of health care reform. Controlling deficits also depends on health care reform. Opponents to change are stifling progress and they will lose out eventually.
I have seen health care in both Canada and the UK, (my father lived in Canada for 15 years, and in the UK for another 15). He waited nearly 2 years for open heart surgery in the UK. His costs were nothing. Overall, he recieved adequate care and is in good health, however, there is a particular issue that never seems to gert raised. Canada provides health care for 33 million people, the UK for 60 million. We are discussing a government program for 300 million. When discussing costs, it is irresponsible to not extrapolate. Canada spends 160 billion for it's 33 million. Times ten and under current conversion rates, that's 1.44 trillion. The UK spent 98.6 billion pounds for 66 million, which would equate to 1.31 trillion. Seems to be a trend here ... Can we afford this?
Murph
Murph: I think the key is to look at the per capita rate we pay as a proportion of gdp; 16% in the U.S., 10% in Canada, just over 8% in Britain. As I point out in the article, their systems are, for all intents and purposes, largely publicly-financed and operated. The plan working through Congress still gives private industry a large role - too large I would argue - but nonetheless, a prominent role in the current efforts at reform.
Personally, I don't believe the bill goes far enough in controlling for the inherent market failures of private insurance, and as a result, I fear costs will continue to rise.
Please stay tuned to this series as I explore other universal systems and how they do it.
Italy has socialized medicine and look who came to the US for a heart operation. A man who, like Obama "has the best plan available", but....
www.washingtonpost.com/wp-dyn/content/article/2006/12/18/AR2006121800409.html
"Former Italian Premier Silvio Berlusconi underwent successful heart surgery Monday in the United States, his party said.
The operation at the Cleveland Clinic heart center in Ohio was "necessary to correct a problem with the (heart) rhythm," said a statement issued in Rome by Berlusconi's Forza Italia party."
Are you unable to take off the partisan blinders, Que?
I don't doubt that people have come to the U.S. for care - similary, people in the U.S. have gone to Canada, Mexico, and India to receive care. For all of the successes of universal health care, each system is different, and each has its own problems. When taken relative to each other, the U.S. has such poor health outcomes that any patriot should be embarrassed, outraged, and should expect more from what we believe is the best country in the world.
I am aware of the imperfections of other systems - I've written about them. Perhaps you should educate yourself to the imperfections of your own.
you folks dont even write your own comments. Atleast Jenny has the ability to think for herself, instead of copying links and pasting them on comment boards.
You tell'em Brad. What a GEEK.
Oh Brad, " Atleast" is two words not one.
"GEEK." How original. I'm glad to see the spell check Nazi's are back in full force. And I thought stupidity was the biggest irritant on this forum...
Que said: "Italy has socialized medicine and look who came to the US for a heart operation. A man who, like Obama "has the best plan available", but....
www.washingtonpost.com/wp-dyn/content/article/2006/12/18/AR2006121800409.html
"Former Italian Premier Silvio Berlusconi underwent successful heart surgery Monday in the United States,..
"The operation at the Cleveland Clinic heart center in Ohio was "necessary to correct a problem with the (heart) rhythm," said a statement issued in Rome by Berlusconi's Forza Italia party."
So a very wealthy man made a choice to come to the U.S. for a heart operation. Cleveland Clinic is considered one of the best at what they do.
That doesn't "prove" anything. There are thousands of different kinds of operations people have not heart related. Many also travel outside the U.S. for treatment, because some a health provider somewhere else does it better. We don't know why he came here, may have nothing to do w/socialized medicine.
Article about U.S. people going abroad for their healthcare:
"The number of people heading abroad for "medical tourism" could jump tenfold in the next decade, to nearly 16 million Americans a year seeking cheaper knee and hip replacements, nose jobs, prostate and shoulder surgery, and even heart bypasses, according to a forecast by health care consultants at the Deloitte Center for Health Solutions."
www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/08/03/BUGA121GPF.DTL&type=health#ixzz0MJkPsKSS
"Surgery in some of the countries that have become hubs for medical tourism, from Thailand and Singapore to Mexico and Brazil, can cost less than half the U.S. price, even when including outlays for airfare, hotel and meals abroad. In a few cases, procedures overseas can cost one-tenth as much, Keckley said."
"Many of these countries actively market their programs in wealthier nations and have new, 21st-century hospitals. Most of their physicians are trained in the U.S."
Purely free enterprise based healthcare and payment systems are deeply flawed because the competitive pricing factors do not work the same as other commodities.
Kenneth Arrow is a brilliant economist who published a paper about it in 1963.
"[Kenneth Arrow] was one of the recipients of the 2004 National Medal of Science, the nation's highest scientific honor, presented by President George W. Bush for his contributions to research on the problem of making decisions using imperfect information and his research on bearing risk."
source: Kenneth Arrow summary on Wikipedia.
Uncertainty and the welfare economics of health care by Kenneth Arrow
link in Krugman's article from the World Health Organization
Why markets can’t cure healthcare
by Paul Krugman
Krugman's New York Times blog 7/25/2009
Toward a 21st-Century Health Care System: Recommendations for Health Care Reform
Annals of Internal Medicine
Kenneth Arrow, PhD; el al.
"1. Replace the current fee-for-service payment system with a payment system that encourages and rewards innovation in the efficient delivery of quality care. The new payment system should invest in the development of outcome measures to guide payment."
They had 7 other recommendations.
An article by an American doctor stated that people in England who are over the age of 59 cannot get a stent for their coronary arteries. Please indicate, ASAP, if this true.
Absolute nonsense. People of all ages are treated absolutely equally. If they need it, they get it, regardless of age or anything else.
You have people that live in countries with socialized medicine coming here for medical care. What does that say to you? Help us stop Obamacare and sign the only REAL repeal out there. http://bit.ly/therepealpledge
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