Comparing the NHS to the health care systems of other countries: five charts

Today we released a report analysing how the NHS compares to the health care systems of other countries. To do this, we looked at a ‘basket’ of 19 comparable countries and how they performed across a range of measures, from spending on health care to patient outcomes. Overall, the NHS is given a mixed bill of health, though on some critical measures the UK is falling well below average. The full report analyses many sources, but in this blog, we pull out just five measures to illustrate the mixed bag of findings.

1. NHS spending performs well on some efficiency measures

For some measures of efficiency, the UK performs better than some other countries. For example, the UK spends less on administration (as a share of total health spending) than comparable countries. This is evidence of efficiency, but it is important to note that good standards of administration are necessary for a health care system to run smoothly.

The UK also performs well on some other measures of efficiency, including the rate at which it prescribes generic versions of medicines, which are cheaper (but chemically identical) to their branded counterparts. Here, out of our basket, the UK has the highest proportion of spending on generic drugs (85 per cent of total drug expenditure).

2. Patients are better protected from high medical costs

Another area where the UK performs relatively well is providing universal health coverage with a low level of private spending. This may sound obvious to someone living in the UK who is used to an NHS free at the point of use, but it is worth highlighting, as this protection from cost is not afforded to people in many other countries. Relatively few people in the UK cannot pay medical bills or skipped medical visits because of the cost of care.

However, there is still room for improvement. While government funding covers 93 per cent of total spend on hospital care, the percentage is lower for dentistry (46 per cent) and prescriptions (59 per cent), meaning people face a greater burden of costs in these areas. The Commonwealth Fund survey found that more people in the UK skip dental care than medical care, and that lower income households are more likely to avoid both types of care. While adult social care was not in scope for this report, it is another area where costs can be burdensome.

3. The UK has less medical equipment and fewer beds

Spending on health care increased substantially in the UK during the Covid-19 pandemic. But despite this, spending per person remains lower than the average for our basket. This impacts on the patient experience. For example, although there is no objectively ‘ideal’ number of scanners, the UK has fewer CT and MRI scanners than any of the comparator countries, which could be a reason – alongside shortages of imaging staff – for why diagnostic waits in the UK are so high.

The UK also has fewer hospital beds; 2.5 beds per 1,000 people, compared to an average of 3.2 beds per 1,000 in our basket. Again, fewer beds are not necessarily bad – this could reflect shorter hospital stays – but the high occupancy rates of beds in the UK (88 per cent in 2022/23, above recommended levels, and third highest in our basket) implies there is a shortage.

4. The UK has fewer doctors and nurses

Another area where the UK is strikingly different to comparator countries is in staffing. The below chart shows fewer doctors and fewer nurses per 1,000 people than the average in our basket. While some countries do, for example, have fewer nurses, many counterbalance that by having more doctors. The UK is remarkable as it scores low on both. High vacancy rates and staff dissatisfaction show that the current number is insufficient.

And, concerningly, evidence suggests more current staff are thinking of leaving; a Commonwealth Fund survey of primary care doctors in ten high-income countries found that those in the UK were most likely to plan to stop seeing patients in the next three years.

5. Patient outcomes are worse than average

The UK has higher avoidable mortality and treatable mortality¹ rates than comparator countries. This is driven by below-average survival rates for many major cancers (including cancer of the breast, cervix, colon, rectum, lung and stomach), and poorer outcomes from heart attacks and strokes.

The volume of cancer-related surgeries and surgeries for cataracts, knee and hip replacements fell more sharply in the UK in 2020 compared to 2019 than it did in our basket of countries. This could further impact patient outcomes.

Conclusion

These five charts give a flavour of what the full report shows: the UK does better than comparable countries in some areas, and worse in others. There is little evidence that one individual country or model of health care system performs better than another across the board. Countries improve health care for their populations mainly by reforming their existing model of health care rather than adopting an alternative. Rather than unwinding the NHS, we should seek to improve it, and there is a lot to learn from other countries when doing so.