The United States and the UK both face challenges in maximizing the benefit of dollars and pounds spent on healthcare. In both countries, wasteful spending on medical tests and procedures are common.
In 2017 the UK spent around the median for Organisation for Economic Co-operation and Development (OECD) member countries on governance and financing costs for healthcare (Figure 2). This is below the average for tax-based health systems.
Costs
As the world works towards universal health coverage, there are many questions about how best to provide affordable and quality healthcare. This report examines the health systems of England and Taiwan, both countries that are able to offer universal coverage, as well as the United States, which struggles with providing affordable care to all its citizens. This analysis will also consider the democratic structure of these three nations, evaluating their ability to promote civic engagement and the health system’s effectiveness in the context of a democracy.
In the UK, four-fifths of its healthcare costs are paid for through public revenues, which mainly come from taxation. This is one of the highest shares of public funding for healthcare among Organisation for Economic Co-operation and Development (OECD) countries with comparable data. This is due to governance and financing costs associated with a predominantly insurance-based healthcare model.
Inequality
The United States is one of the few countries that still rely primarily on private insurance to fund healthcare. As a result, the US has high costs associated with governance and financing. This includes spending on procurement, contracts and provider negotiations.
This spending can also be attributed to the litigious nature of health care in the US and the scrutiny that is placed on providers by regulatory bodies. Nevertheless, the US still underperforms other industrialized nations on measures of access and equity for those with low income.
In contrast, the UK’s NHS operates a social insurance scheme that is funded through public revenues, largely taxation. The UK has one of the highest shares of publicly funded healthcare in the OECD, which is similar to other Nordic countries and Japan. The NHS also performs well on objective measures. This raises the question: Why does the US show less interest in learning from Britain’s experience? Is it a reflection of American insularity or British credulity?
Access
The US and UK healthcare systems differ in many ways. The UK uses a socialized system where the government both provides insurance and operates the hospitals. It also allows patients to opt for supplemental private insurance. This approach is similar to the Bismarck model, which is used in countries such as France and Germany.
While it is true that the NHS costs half as much as the US system, it is important to compare like for like. The US system does not include private patient cost sharing, while the UK system does. In addition, private patients must pay a copayment for some services.
Despite this, the UK’s healthcare system is a lot better than that of the USA. Its doctors are highly qualified and offer a wide range of treatment options. They also provide a good level of care, and the government’s insurance schemes are well-designed to avoid cost overruns. Furthermore, the UK has one of the highest life expectancies in Europe, despite spending only a tenth of the US’s GDP on healthcare.
Efficiency
There is a growing concern about the level of healthcare spending in many countries and whether this money is being well spent. In the United States, there is a great deal of waste associated with the high prices for healthcare services and the overuse of tests and procedures. In contrast, the UK spends less per-capita and provides a universal system of healthcare that is accessible to all citizens.
The UK’s national health service is a public single-payer system that operates as a socialized healthcare model. This model uses government revenues to finance healthcare and provides a high level of coverage for all citizens. This is in stark contrast to the US, which operates a private insurance-driven healthcare system.
Both the United States and the United Kingdom are working to reduce wasteful spending. This is done through increased monitoring of the costs of healthcare and the adoption of Choosing Wisely recommendations that help reduce unnecessary testing and procedures.
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