Universal Healthcare Without the NHS: Towards a Patient-Centred Health System

Abstract

Despite some relative improvements in the last fifteen years, the National Health Service remains an international laggard in terms of those health outcomes that can be attributed to the healthcare system. In international comparisons of health system performance, the NHS almost always ranks in the bottom third, on a par with the Czech Republic and Slovenia. The UK spends less on healthcare than many other developed countries, but this must not be mistaken for a sign of superior efficiency. It is mostly the result of crude rationing: innovative medicines and therapies that are routinely available in other high-income countries are often hard to come by in the UK. Any country could keep healthcare spending in check by simply refusing to adopt medical innovation. In more sophisticated estimates of health system efficiency, the NHS ranks, once again, in the bottom third. The NHS is poorly prepared to deal with the financial challenges of an ageing society. This is because, like virtually all health systems in the developed world, it is financed on a pay-as-you-go basis: healthcare costs rise systematically with age, which is why most healthcare spending represents a transfer from the working-age generation to the retired generation. It would be far more insightful to benchmark the NHS against social health insurance (SHI) systems, the model of healthcare adopted by Switzerland, Belgium, the Netherlands, Germany and Israel. Like the NHS, SHI systems also achieve universal access to healthcare, albeit in a different way, namely through a combination of means-tested insurance premium subsidies, community rating and risk structure compensation.