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The Healthcare System of the United Kingdom PowerPoint PPT Presentation

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The Healthcare System of the United Kingdom. Lecture 5 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems. “No society can legitimately call itself civilized if a sick person is denied medical aid because of a lack of means.”. Aneurin Bevan Minister of Health

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The Healthcare System of the United Kingdom

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The Healthcare System of the United Kingdom

Lecture 5

Tracey Lynn Koehlmoos, PhD, MHA

HSCI 609 Comparative International Health Systems

“No society can legitimately call itself civilized if a sick person is denied medical aid because of a lack of means.”

Aneurin Bevan

Minister of Health


The United Kingdom

  • Population: 59 million

  • Capitol: London

  • Includes: England, Northern Ireland, Scotland and Wales

  • Government: Constitutional Monarchy

UK: Updated Information

  • Population: >60 million in 2006

  • Life Expectancy: 76.1 male/ 81.1 female

  • Infant Mortality: 5.06 per 1000 (2006)

  • Population over 60: 20.8%

  • GDP for healthcare: 7.7% (2002)

  • Per capita health expenditure: $2,031 (US)

Talking about the UK…

  • The United Kingdom consists of England, Scotland, Wales and Northern Ireland

  • Great Britain consists of England, Scotland, and Wales

  • Northern Ireland has its own National Health Service

  • We will not include Northern Ireland in the remainder of our discussion.

Health System Overview

  • National Health Service Act 1948—based on Beverage Report and the belief in post-World War II solidarity.

  • British NHS: National Health Service, first comprehensive, nationalized healthcare program.

  • Highly centralize management and finance

  • Patients choose their provider

  • Providers can have public & private practices

Structural Changes to NHS

  • Secretary of State for Health

  • Department of Health (NHS)

  • Strategic Health Authorities (like RHA’s)

  • Primary Care Trusts (like DHA’s)

  • Hospitals: NHS Trust (semi-independent)

  • This represents a strong move toward internal market competition—more like managed care

Strategic Health Authorities

  • 28 Strategic Health Authorities since 2002 to manage the local NHS.

  • Responsible for:

  • Local health service planning

  • Monitoring quality

  • Increasing the capacity of local health services

  • Priority service integration - for example, programs for improving cancer services

  • Strategic Health Authorities manage the NHS locally and are a key link between the Department of Health and the NHS.

Primary Care Trusts

The center of the NHS, control 80% of the total NHS budget

  • PCTs are responsible for:

    • Assessing the health needs of the local community.

    • Commissioning the right services, for instance from GP practices, hospitals and dentists.

    • Improving the overall health of their local communities.

    • Ensuring access to services

    • Monitor interaction of social and healthcare organizations.

    • Annual assessment of GP practices in their area.

    • Buy and monitor services

      There are more than 300 PCTs covering all parts of England since April 2002, which report directly to their local Strategic Health Authority.

Private Market

  • 12% of Britons have Supplementary Insurance--an employment perk

  • Doctors & hospitals treat both public and private patients

  • Private insurance pays for dental, vision, some prescription drugs (although 80% of all prescription drug payments are waived due to age, pregnancy, youth, poverty)

Economic Factors

  • Revenues

    • 83% NHS funding from taxes

    • 13% from employer-employee contributions

    • 4% User fees

  • Expenditures

    • NHS accounts for 88% of health expenditures

    • Private Insurance (SI) 4% of expenditures

    • ~3/4 of NHS budget goes to workforce salaries

    • 1/10th of NHS budget goes for drugs


  • Central authority for national health planning, budgeting and legislation.

  • Distribution of funds and delegation of planning to Strategic Health Authorities

  • Administration (streamlined compared to previous set-ups) is vital to success of the new system—emphasis on strategic planning, evaluation, budgeting and internal market competition.

Health Services Workforce

More than 1 million employees, largest single employer in Europe

  • MD’s: 2.1 per 1000 pop (low #) (OECD 2002)

  • General Practitioners (GPs): 60%

  • GPs handle 90% of episodic care; gatekeepers

  • GPs paid by mix of capitation, salary, fees

  • Specialists are hospital based, called “Consultants.”

  • Specialists/Hospitalists are salaried

  • All MD’s can have public and private practices

Health Services Workforce

  • Nurses largest group within NHS staff

  • 40% of NHS budget

  • Nurses are trained specialist (child, MH)

  • Work closely with GPs in the community

  • Hospital nurses, much dissatisfaction salaries, working conditions, work load.

  • Nursing shortage

  • NHS is actively recruiting Indian, Spanish and Philippine nurses to make up for shortages in the field.


  • More than 2000 public or NHS trust hospitals

  • About 300 private/surgical procedure facilities

NHS Trusts (Hospitals)

Emergency and planned hospital treatment

  • Hospitals in the NHS are managed by NHS Trusts .

  • Their wide-ranging services are commissioned – or purchased - on behalf of patients by Primary Care Trusts (PCTs) and include treatments where patients are admitted to hospital, day surgery and out-patient services where patients attend consultations and clinics.

  • NHS Trusts employ most of the NHS workforce: consultants, doctors, nurses, hospital dentists, pharmacists, midwives and health visitors, managers and IT specialists, physiotherapists, radiographers, podiatrists, speech and language therapists, dieticians, counselors, occupational therapists and psychologists.

  • Hospital treatment is arranged through a GP, except emergencies.

  • Appointments and treatment at NHS hospitals are free.

NHS Foundation Trusts

  • New type of NHS hospital run by local managers, staff and members of the public.

  • Only the highest performing hospitals can apply to become NHS Foundation Trusts – a status which gives them much more freedom in running their services than other NHS Trusts.

  • The creation of Foundation Trusts illustrates the shift of decision-making power to frontline-staff and the local communities they serve.

  • However, Foundation Trusts remain firmly within the NHS and its framework of standards.

Long Term Care

  • Community Care Act of 1990 reduced government role to only covering nursing services (unless indigent)

  • Most LTC takes place in private sector

  • Private, supplemental LTC ins is available

  • State Equity Release Scheme

    • From October 1 2001 a permanent resident in a care home in England need not sell their own home to fund their long term care fees.

Current Issues in the UK

  • Aging population

  • High cost of advanced technology and its impact on tight budgets

  • Increased incidence of serious and expensive to treat diseases (cancer, HIV/AIDS)

  • On-going problems with long queues and rationing

Compared to US

  • Single payer system

  • Surgeries and new technologies underused

  • New efforts to decrease UK waiting times

  • All access system

  • US, 44 million uninsured, no access

  • Tremendous cost control and access but a definite lack of quality compared to US


  • National Health Service

  • Centralized, publicly financed system

  • Cradle-to-Grave care (except LTC!) for all citizens

  • Largest employer in Europe

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