Why we did the research
The current pressures on NHS services and 75th anniversary of the NHS’s founding mean this is a particularly important moment to assess how the UK’s health care system is faring compared to its peers. Every health care system has ‘something to teach and something to learn’. So, comparing the health care systems of different countries can help UK politicians and policy-makers assess the performance of the UK health care system and identify where it can improve.
What we did
We compared the health care systems in different countries by doing three things. First, we reviewed the research literature and assessed previous attempts to rank and compare health care systems. Second, we interviewed academic experts in international health care policy and experts who had extensive knowledge of the UK, German and Singaporean health care systems. Third, we analysed the latest quantitative performance data for the UK health care system and the health systems of 18 higher-income peer countries.
We analysed data in three main domains:
- the context the health system operates in (eg, the health status and behaviours of the population)
- the resources a health system has (eg, levels of staffing, equipment and health care spending)
- how well the health care systems uses its resources and what it achieves as a result (eg, measures of efficiency in delivering services, quality of care, financial protection from the costs of ill health, and health care outcomes).
What we found
A system with fewer resources
The UK has below-average health spending per person compared to peer countries. Health spending as a share of GDP (gross domestic product) was just below average in 2019 but rose to just above average in 2020 (the first year of the Covid-19 pandemic, which of course had a significant impact on the UK’s economic performance and spending on health services). The UK lags behind other countries in its capital investment, and has substantially fewer key physical resources than many of its peers, including CT and MRI scanners and hospital beds. The UK has strikingly low levels of key clinical staff, including doctors and nurses, and is heavily reliant on foreign-trained staff. Remuneration for some clinical staff groups also appears to be less competitive in the UK than in peer countries.
A mixed record on efficiency and quality
The UK health system performs relatively well on some measures of efficiency, such as the rate at which cheaper generic medicines are prescribed. The UK also spends a relatively low share of its health budget on administration.
But waiting times in the UK for common procedures like knee, hip and cataract operations were broadly ‘middle of the pack’ compared to peer countries in 2019 (before the Covid-19 pandemic). And the fall in activity for these procedures in the first year of the pandemic was dramatically sharper in the UK than in peer countries.
Good financial protection but poor health care outcomes
People in the UK receive relatively good protection from some of the catastrophic costs of falling ill. Relatively few core NHS services are charged for and certain population groups are exempt from charges. But financial protection is weaker for some services, such as dental care, and there is growing concern that people in the UK may be forced to choose between funding their own care or enduring longer waits for treatment.
But the UK performs noticeably less well than its peers – and is more of a laggard than a leader – on many important measures of health status and health care outcomes. These include health outcomes that can be heavily affected by the actions of a health system (such as surviving cancer and treatable mortality), and outcomes such as life expectancy, which are significantly affected by factors beyond the direct control of any health system.
There is little evidence that one individual country performs consistently better than another across a range of performance indicators. Even countries such as Germany and Singapore, that score highly on several health system performance measures, are facing the challenge of rising demand from a growing and ageing population and the need to improve health care outcomes.
There is also little evidence that one ‘type’ of health care system or health care financing model achieves consistently better results than another. And the costs of transitioning from one system to another can be significant. As a result, countries predominantly try to achieve better health outcomes by improving their existing model of health care, rather than by adopting a radically different model.
About this report
Thank you Siva Anandaciva for your strong attempt at comparing UK health system and other comparable bunch, it is a very useful resource. It is interesting looking at some of the measures used. Just a quick request: You have a very good structure for the report. However, adding "Why we did what we did" will help readers make better sense of underpinning thinking around the report and overall appreciation of the outcome. You added why the research was commissioned, but why we did what we did would be a good follow-up for what we did and a strong base for other researchers to start thinking around approach for future work around this topic area.
I find it incredible that supposedly intelligent politicians can come to the conclusion that giving a large proportion of of what we pay for health and care towards a private company's profits rather than spending it ALL on H&C, is a clever idea. Insurance companies are the worst because they don't actually DO anything useful. They consult actuarial tables, drive up the fees that medical practitioners charge, encourage practitioners to do unnecessary procedures and take bribes from drug companies - often for drugs that don't work any better than others and sometimes do actual harm. I could go on.
I'm 77 years old. At the beginning of this year I was lucky enough to see a surgeon who agreed that he would replace my worn out knee joints. At this time I could not walk more than 25m without severe pain. When I asked when he could do it he said, well, not this year. Having seen the NHS deteriorate over the previous 13 years and and seen the difficulties the service faces now, it took me less than a week to ask for a private appointment with the same surgeon. He did the operation 6 weeks later in a private hospital, the other knee is being done next month. It is costing me £30k of my hard earned savings. I can't help thinking that if I had paid that extra £30k in taxes over that 13 year period, it would not only have paid for a timely knee operation but speeded up all the other acute or chronic treatment I had.
Health Insurance is a massive con-trick. We should value our health and be prepared to pay for it in our taxes. Then none of what we pay goes to the profits of insurance companies.
Many people who live in the UK have never experienced healthcare in other countries. They believe the hype that the UK health system is superior, and have no idea the UK health system is a laughing stock to many other developed countries.
e.g 6 week waiting times for MRIs in the UK. Pay £25 in Turkey get an MRI immediately.
Its the workforce that keeps the economy going and we should be kept in good condition, we should have no expense spared healthcare to get the workforce back in to action when we are taken out of action by illness or injury. But no, we are provided healthcare on a shoestring, the bare minimum. People who could be cured and back working are out of action for months or years, due to waiting times for the most basic of things - blood test, mri, xray. I have friends whose lives have been ruined because they have been left to rot by the NHS with delays, misdiagnosis and no diagnosis at all.
Visit a hospital ward in the UK, they are a shambles, with no clear system or leadership amongst the staff, and mistakes being made with patients left right and centre because of the level of disorganisation.
Anyone who has not experienced healthcare in another country I implore you, go to Turkey, Switzerland, Germany and see how much better you get for your money.
The UK government is taking money off the workforce for healthcare but not putting it back in to healthcare, leaving many people who could be quickly cured to rot.
1998 my left hip was severe and excruciating pain aged 56. The Consultant said "this xray worse than the last. There is an 18month waiting list, you will be crying out for it then Goodbye. I got even worse, a recluse I could not walk, my left buttock atrophied and I limped and had to use a wheelchair. Operation was January 2000 and months and months before I could walk and limped. The muscles wasted in my left buttock. Never had a true answer. 2002 my right hip replaced. Now arthritis in my shoulder and a steroid injection.
Varicose vein operation left leg, the operation very painful, I felt the very hot liquid injected, the operations was not properly ended. The Senior Consultant offered to put it right, the South Funding for 5 years refused his kind offer and my leg got worse and worse, the black veins around my ankle, my calf much bigger, still they did not care until I got exema etc. I had to go through Benenden, another operation very painful and leg even worse. Another operation still worse than ever. They will not agree to another operation, my doctor told me the nhs will not do the operation.
My mother was a victim of being put on a pathway to death even though not dying, but memory test of 2. i was barefaced lied to by the hospital, local police and two coroners' turned their backs on my plea for justice. I have been since 1998 in complete dispair.
I do not understand why people cannot be asked to pay a small fee for a visit to the GP, A & E, etc. I do not mean hundreds of pounds but a small fee based on age and or employment status. For example, children and teens under 18 must be free from fees. However, twenty - thirty year olds could pay a fee that could also be indexed against any earnings they have. As people reach their 60s to 70s, then the fee could drop to a very low contribution. I no longer live in the UK and when I visit, I live in fear of needing an ambulance as there seems to be a severe shortage. During my last visit, a woman fell in the middle of a road, shattered her hip, and lay in the pouring rain for almost eleven hours! Yes you read that right. She lay there for eleven hours while people did all they could to keep her warm and as dry as possible, and stayed with her until a family member could come. She was in so much pain they could not possibly get her into a car or taxi to take her to A&E, so she stayed there until later in the evening when the ambulance came. This is an appalling story and sadly true; she later died from shock due to pain and her age. She was in her 80s. This woman should not have had to suffer like that in 2023 in a first world country. I do not now who is to blame for this kind of outrage but it is becoming clear to me that Tories of all stripes are determined to sell the NHS to the Americans, and that will be its death knell.
Thanks for your comment.
You should be able to download the report at the top of the page, but you can also follow this link: https://www.kingsfund.org.uk/sites/default/files/2023-06/How_NHS_compar…
Hope this helps.
I would like a copy of the full report but I do not seem to be able to download it. Can I just buy it?
What do other pressure groups make of your report
I emigrated from the UK to Spain in 1999. Since then I can only say that my experience of the Spanish system has and continues to be far superior to that of the UK system. Why you hold the NHS on a pedestal has always appeared to be "living in a bubble". The reality is much different. And for those that want to have private treatment In Spain, you only have to pay about 50 euros per month, not hundreds as in the UK. And before Brexit there were many older Brits coming down for hip replacements etc (free of charge btw) because there were not the delays you are accustomed to. Something has gone seriously wrong in the UK with your health system over the last forty years!
"Always remember these facts, Thatcher started the Privatisation of Our NHS, John Major started the PFIs, Blair carried on with them, putting the NHS in massive debt, that is taking 52 years to pay off. Jeremy Hunt was the architect of the full Privatisation, that’s why Cameron made him Health Minister, from day one, he started breaking it up, running it down and introducing more and more Privatisation. The Tories have closed Wards, Beds, Hospitals and A&Es, created the conditions that have made the NHS short of 45.000+ Nurses, plus 20.000+ Doctors and GPs short, along with tens of thousands of ancillary staff.
They’ve allowed, GPs to sell their Surgeries to Centene, the United States’ biggest Health Insurance Corporation.
All NHS Dental Services are now run by Private Companies. They will not stop this privatisation until the last department is run by Private Companies. Then you will see the US Health Corporations moving in and buying them all up.
From then on, millions will suffer and die prematurely, because they will not be able to afford ANY Health Insurance. 40 million Americans cannot afford any Health Insurance and have a life expectancy 10 years less than those that can. 63% of all Bankruptcies in the United States is Health related, where families sell, their homes and other belongings to save loved ones from suffering and/or Dying. Starmer and Streeting have both taken £thousands from Private Health Companies and have said, they will also be bringing more Private Companies in to run parts of the NHS, using the pathetic statement, “To help the NHS”!!!"