Why does the NHS work

The UK healthcare system

The UK health system is based on the idea of ​​the welfare state. In 1948 the National Health Service (NHS) was launched, which to this day occupies a special position in the health policy of Western democracies: It is the prototype of state health care. The idea: The state health system should guarantee better public services and thereby generate lower costs.

The NHS is largely funded from tax revenues. Only a small part is covered by social security contributions.

Most of the use of the NHS is free. Patients only have to pay their own share for a few services. For example, co-payments for prescriptions, glasses or dentures are the rule.

With over 1 million employees, the NHS is the largest civilian employer in Europe. It is estimated that over 90 percent of UK doctors are employed by the NHS. Yet they are not government employees. The British Medical Association, the British medical association recognized as a trade union, negotiates medical fees with representatives of the Department of Health.The NHS is a state body with direct government responsibility. It reports to the UK's four health ministries (England, Scotland, Wales, Northern Ireland) and is managed by its own civil service, the NHS Executive (NHSE). The NHSE in turn has eight regional offices in England, which occupy an important position in the chain of responsibilities between the lowest level and the head office. For example, you are responsible for implementing national health policy decisions at regional level. The local Health Authorities (HA), the authorities actually responsible for operational health management, are located below the Regional Offices. The HA receive a budget from the NHS that is based on the number of residents to be served.Since 1990 the organization of the UK health system has undergone some fundamental changes. For example, patients were given the option of free choice of doctor. Under Margaret Thatcher, supply and demand structures were introduced in the NHS that were supposed to generate efficiency gains without incurring new costs. The La bour party criticized this principle from the outset, which ultimately did not bring about any improvements. She saw a shift in priorities away from proper care

Looked at cost-benefit decisions. After Tony Blair took over the government, extensive organizational changes took place. The intention of the Labor Party was to replace the competitive situation with partnership-based cooperation between the parties involved.The responsibilities of clinics and general practitioners are clearly defined in Great Britain. Outpatient care is primarily provided by general practitioners (GP), dentists and ophthalmologists. 95 percent of all initial contact between patients and the healthcare system takes place through general practitioners who mainly work in group practices.

The hospitals are responsible for inpatient and outpatient specialist care. 95 percent of the beds are in NHS hospitals, the rest are privately owned. In contrast to Germany, specialist medical treatment takes place exclusively in the outpatient departments of the hospitals. Specialists who work in clinics are allowed to operate private practices. However, the patients have to bear all of the costs themselves.

The main problem facing the UK healthcare system is chronic underfunding. However, the growth in expenditure in the public health system is low compared to other European countries. The average expenditure quotient in the OECD countries rose between 1980 and 1998 from 6.9 to 8.3 percent of the gross domestic product. In Germany, the share of health expenditure in GDP rose - as a result of reunification - from 8.8 to 10.3, in Great Britain only from 5.6 to 6.8 percent. Health spending in the UK remained at a relatively low level in 2000 as well. The British, at 7.3 percent of their GDP, were below the OECD average of 8.0 percent. Germany spent 10.6 percent of its GDP on health services.

One consequence of this scarce funding is the emigration of many British doctors and nurses who can earn more abroad and sometimes find better working conditions there. The most serious problem, however, is the supply bottleneck caused by declining hospital capacity. Britain holds the sad record of the longest waiting lists in Western Europe. In particular, they hit people who would have to perform non-vital operations such as hip joint operations.Because of these bottlenecks, British patients with acute health problems and severe pain have been treated in expensive private clinics since the beginning of the year or have been referred to other Western European countries for operations - at state expense. The Blair government's practice of sending NHS patients abroad for surgery is not shared by many British medical professionals. However, a survey by the British Medical Association (BMA) found that a quarter of patients would be willing to go abroad for surgery - out of disappointment with the UK healthcare system.

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