the healthcare system of united kingdom

8/22/2019 The Healthcare System of United Kingdom

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The Healthcare System of the

United KingdomLecture 5

Tracey Lynn Koehlmoos, PhD, MHA

HSCI 609 Comparative International HealthSystems


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No society can legitimately callitself civilized if a sick person is

denied medical aid because of alack of means.

Aneurin Bevan

Minister of Health1946


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The United Kingdom

Population: 59 million

Capitol: London

Includes: England,

Northern Ireland,Scotland and Wales

Government:

ConstitutionalMonarchy


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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)


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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 NationalHealth Service

We will not include Northern Ireland in theremainder of our discussion.


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Health System Overview

National Health Service Act 1948basedon Beverage Report and the belief in post-World War II solidarity.

British NHS: National Health Service, firstcomprehensive, nationalized healthcareprogram.

Highly centralize management and finance Patients choose their provider

Providers can have public & privatepractices


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Structural Changes to NHS

Secretary of State for Health

Department of Health (NHS)

Strategic Health Authorities (like RHAs) Primary Care Trusts (like DHAs)

Hospitals: NHS Trust (semi-independent)

This represents a strong move towardinternal market competitionmore likemanaged care


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Strategic Health Authorities

28 Strategic Health Authorities since 2002 tomanage 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 theDepartment of Health and the NHS.


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Primary Care TrustsThe 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 servicesThere are more than 300 PCTs covering all parts of England

since April 2002, which report directly to their local StrategicHealth Authority.


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Private Market

12% of Britons have SupplementaryInsurance--an employment perk

Doctors & hospitals treat both public andprivate patients

Private insurance pays for dental, vision,some prescription drugs (although 80% ofall prescription drug payments are waiveddue to age, pregnancy, youth, poverty)


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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


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Management

Central authority for national healthplanning, 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 systememphasis on strategicplanning, evaluation, budgeting andinternal market competition.


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Health Services Workforce

More than 1 million employees, largest singleemployer in Europe

MDs: 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 MDs can have public and private practices


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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 inthe field.


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Hospitals

More than 2000 public or NHS trusthospitals

About 300 private/surgical procedurefacilities


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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-patientservices where patients attend consultations and clinics. NHS Trusts employ most of the NHS workforce:

consultants, doctors, nurses, hospital dentists,pharmacists, midwives and health visitors, managersand IT specialists, physiotherapists, radiographers,podiatrists, speech and language therapists, dieticians,counselors, occupational therapists and psychologists.

Hospital treatment is arranged through a GP, exceptemergencies.

Appointments and treatment at NHS hospitals are free.


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NHS Foundation Trusts

New type of NHS hospital run by localmanagers, staff and members of the public.

Only the highest performing hospitals can apply

to become NHS Foundation Trusts a statuswhich gives them much more freedom in runningtheir services than other NHS Trusts.

The creation of Foundation Trusts illustrates the

shift of decision-making power to frontline-staffand the local communities they serve.

However, Foundation Trusts remain firmly withinthe NHS and its framework of standards.
http://www.nhs.uk/England/AuthoritiesTrusts/Acute/Default.aspx


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Long Term Care

Community Care Act of 1990 reducedgovernment role to only covering nursingservices (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 ina care home in England need not sell theirown home to fund their long term care fees.


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Current Issues in the UK

Aging population

High cost of advanced technology and itsimpact on tight budgets

Increased incidence of serious andexpensive to treat diseases (cancer,HIV/AIDS)

On-going problems with long queues andrationing


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Compared to US

Single payer system

Surgeries and new technologiesunderused

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


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Summary

National Health Service

Centralized, publicly financed system

Cradle-to-Grave care (except LTC!) for allcitizens

Largest employer in Europe

the healthcare system of united kingdom

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