NHS AND INTERNATIONAL HEALTH CARE SYSTEMS

NHS And International Health Care Systems

NHS And International Health Care Systems

Introduction

Comparing health systems is a difficult task. The toughest part is to decide on what to compare. Should we compare the health indicators of the country under different systems or their outputs or the satisfaction of the consumers? A comprehensive scale that encompasses all may be difficult to achieve. As a patient, access and quality of care may be more important; as a doctor, working conditions, pay, and lifestyle may be more important.

In 2000 the World Health Organization ranked the performance of the health system in each of its member states.[ World Health Organization. The World Health Report 2000: Health Systems: Improving performance. Geneva 2000: World Health Organization.] France took the top spot, and Sierra Leone the bottom. The UK was ranked 18th and the US 37th, only two spots above Cuba. Australia was at 32 and Japan at 10. However, the criteria used, the method for ranking systems, and shortcomings in the data have been criticised.[ Navarro V. Assessment of the World Health Report 2000. Lancet 2000;356:1598-601.]

In a comparison of deaths in 19 industrialised nations that should not have occurred with effective health care, France and Australia were in the top five and the US, the UK, and Ireland in the bottom five (figure 1). (Nolte E, McKee CM. Measuring the health of nations: updating an earlier analysis. Health Affairs 2008;27:58-71)

Another comparison of six countries by the Commonwealth Fund, based on long, healthy, and productive lives; quality; access; equity; and efficiency, ranked the UK first followed by Germany, Australia, New Zealand, Canada, and the United States ( Table 1 ).[ American College of Physicians. Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Ann Intern Med 2008;148:55-75]

Figure 1. Deaths that should not occur with effective health care, 2002-3

The Netherlands came first in a recent comparison of 31 European countries on 34 quality indicators that focused on patients' perspectives. The UK came 13th.[ Watson R. Netherlands tops health care table that focuses on patients' perspectives]

Clearly ranking health systems is difficult, and it is worthwhile looking at systems individually. Indicators such as infant mortality rates have been used as a measure of health system performance for many years, especially in developing countries, because they relate to quality, effectiveness, and accessibility of healthcare services in the community (Table 2) (World Health Organization. WHO Statistical Information System. www.who.int/whosis/)

Table 2. Health and Economic Indicators in 2006

A brief history of UK health services

The beginning

The UK National Health Service (NHS) is one of the largest organisations in the world and the largest in the UK. Its estimated budget for 1998-1999 is some £46 billion and it employs almost one million people. Established in 1948 by the post-Second World War Labour Government, it was the first health system in any Western society to offer free medical care to the entire population: it was intended to be universal in coverage, comprehensive in terms of services ...