Who has the world's best healthcare system: the US or the UK? Neither
Henry Featherstone 3:46pm
In an email this morning, David Cameron told me (and thousands of others registered for the Conservative conference) that he is proud of the NHS. Me too. Call it Orwellian if you like, but equitable access to healthcare is a pretty good thing.
But who has the best healthcare system, the USA or the UK? Answer - neither. While total spending on health is very different - 9% of GDP in the UK and 17% in the USA - the extent to which both healthcare systems save lives show the USA as the worst in the developed world and the UK not far behind. France, Japan and Australia are the best.
Moreover, it is interesting to point out that while the other nations have improved dramatically in reducing preventable deaths between 1997–98 and 2002–03, the USA has improved only slightly. The preferred measure, ‘decline in amenable mortality’ in all countries averaged 16% over the period studied. The USA was an outlier, with a decline of only 4%; the UK among the best with a 20% reduction.
But is this improvement related to spending? Not necessarily. Over the period of the study above total spending per capita (US$ purchasing power parity) grew across the board: UK by 79%, USA by 62%, Australia 61%, and France 53.2%. So without radical reform healthcare costs in the USA will continue to spiral and lives that could be saved will be lost. The same could be said about the UK.
Instead of arguing about which flawed healthcare system should be adopted, the question should be, 'How do we deliver better outcomes for less money?' In France, Australia (and the USA), patients have pretty much unrestrained choice over which doctor to visit. However, the incentive structures in the USA lead to costly oversupply of services without consideration to the value they provide. Experts suggest up to 30% of total spending in the USA could be saved by changing this incentive structure.
In the UK - despite the political rhetoric - choice is confined to patients choosing hospital rather than individuals being able to choose GP, physician or surgeon. There is little or no information on relative performance at individual physician level so competitive pressures for improvement are absent. Although oversupply is much less in the UK, payment systems still reward activity rather than clinical quality or improved outcome.
So perhaps the healthcare reformers in the USA should be looking across the Pacific instead of the Atlantic, and those in the UK even venturing across the channel.
Henry Featherstone is Head of Policy Exchange’s Health and Social Care Unit.
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Dirty Euro
August 14th, 2009 4:51pm Report this commentI am annoyed at Americans saying they have the best healthcare in the world. There is not any evidence for it. They always say it is because lots of people travel to the USA for their healthcare well many people travel to India form the USA for operations does that mean India has the best health care.
Rhoda Klapp
August 14th, 2009 5:06pm Report this commentThis is the sort of debate we should be having. These are the comparisons which should have been made by Wanless in 2001, except he was not allowed to look at other solutions by Gordon Brown. If the tories had not already dug themselves in, they could move towards this position. It's both principled and pragmatic to look at what is done elsewhere. But no, political expedience got in the way again, as it always will where courage is absent.
strapworld
August 14th, 2009 5:43pm Report this commentDaniel Hannan says:-
"Five different BBC journalists have phoned today That’s the Beeb for you, I suppose: I’ve been setting out my views on healthcare in some detail over the years but, since I’ve been doing so mainly in the Telegraph, our state broadcaster hasn’t noticed.
I am blogging from Dax where the feria is in full swing, the streets swaying with white-clad French people in red neckerchiefs and sashes. I love French ferias, and am still daydreaming of a repetition of this episode. But I am nowehere near a studio, so any journalists wanting a line from me will have to make do with the following.
1. In The Plan, published last year and co-authored with Douglas Carswell, I set out at length a scheme to replace the current government monopoly in healthcare with a Singapore-style system of personal health accounts. The Singapore system produces better outcomes than ours for half the price. If we spent the same percentage of GDP on healthcare as now, but put equivalent power in the hands of our consumers, it seems not unreasonable to suppose that we would be much healthier. (Incidentally, the state pays for those who can’t afford their own accounts in Singapore, as in every developed country. It never ceases to amaze me how many British people have been convinced that free healthcare for the poor is a unique property of the NHS.)
2. I am not the Conservative Party’s healthcare spokesman. I’m fond of Andrew Lansley, and I strongly support David Cameron as party leader. On this issue, though, I disagree with both of them.
3. When I was in Washington last week, I joked that, within minutes of my speech, John Prescott would be accusing me of “insulting our hard-working doctors and nurses”. I over-estimated the old bruiser: it took him a week. The idea that I - or anyone else - would set out to offend 1.4 million NHS workers needs only to be stated to see how silly it is. You see how the Left works, though. Any suggestion that the NHS might be improved upon is shouted down as an attack on the people in it - which is precisely the point I was making about how hard it is to reform so large a bureaucracy.
4. I particularly like Prezza’s idea that being “Progressive” means refusing to countenance any change to a system designed in 1944.
5. It seems increasingly obvious that American voters are turning against Barack Obama’s plans. That’s not to say that the Dems won’t get something called “health reform” through: they have invested too much political capital not to. But British-style state-administered hospitals - that plainly ain’t gonna happen.
6. Which raises the intriguing question of whether Britain would establish the NHS today.
Verity
August 14th, 2009 5:44pm Report this commentWho is Henry Featherstone and why did he miss out Singapore? Malaysia is also very good.
And yes, a lot of people do go to India for excellent treatment, but the discussion is on healthcare for the whole country and India does not yet serve its whole 1.1bn people with the standard of healthcare available in its excellent private hospitals.
Jeff Koons
August 14th, 2009 5:48pm Report this commentI am from the United States and I can say without a doubt, we do not have the best healthcare in the world. People from our country go to Canada or Mexico for cheaper prescription drugs, some go to India for cheaper surgeries. The profit taking in our country is disgusting.
David
August 14th, 2009 6:09pm Report this comment"If the tories had not already dug themselves in"
The only reason they've had to do that is because Hannan spouted his ill-advised claptrap.
"But no, political expedience got in the way again, as it always will where courage is absent."
It takes courage to leap off a cliff, doesn't mean it's the righ thing to do.
One of the most interesting polls of the 2005 election tested the political brand of each party. Regardless of whether they agreed with a statement or not, what actually coloured the response is what party it came from. In other words, a party has to earn the right to be heard, which in a democracy is as it should be. That's what Cameron has been doing, and that is unfortunately what his opponents within the party do not understand, believing that if they simply shout louder, they'll be heard.
RobertD
August 14th, 2009 6:13pm Report this commentThere are two major issues that are not being addressed.
The first is the mismach between when people pay for healthcare (basicially between 20 and 65 while they are employed) and when they use most of the healthcare resources (under 20 and over 65). As the NHS and the private sector of the US work on a pay as you go basis they don't put enough money on one side to cover healthcare needs in later life. Hence the big problems with rationing for end of life care. The contributions have been too low, and been spent too soon. Until this structural issue is addressed there can be no lasting progress. It is not on anyone's agenda.
The second UK specifc problem is the level of patient involvement in chosing their healthcare. It remains a professional stich-up between professional administrators in PCT's and professional admininstrators in hospital trusts, with doctors being increasingly told what they can and can't do and patients being cut out of any meaningful say.
As a minimum the UK needs to go back to were we were in the 1990's with GP's having control over part of the budget. At least patients could talk to them. Now they have a computer that gives them "choices" without explanation or real effect.
The perceived advantage of the US is that, for the majority with insurance, doctors are very responsive to patient needs and preferences. If people are prepared to pay the higher costs involved then that is a choice they should be able to exercise.
Stephen
August 14th, 2009 7:57pm Report this commentThe trouble is we Brits have become very prickly about any adverse comment about our beloved NHS[or as Nigel Lawson calls it our National Religion] The NHS and the Communist State in China are I think both about the same age which has adapted to the world we now live in? The Chinese have abolished the "Iron Rice Bowl" why is both major parties in the UK don't have the guts to say a 60 year old institution conceived out of old fashioned poltics needs a good hard look at!
Rhoda Klapp
August 14th, 2009 8:43pm Report this commentDavid, the tories were dug in months ago. You are multi-posting the saem message. That the tories have to be nulab mk2 to appeal to the voters, and dare not do anything too radical. Or is it dare not declare anything too radical before getting power. Either way, there is no room for a new policy, and there is no way the health provision in this country may be fixed. But you persist in putting it in terms of evcil right-wing loonies who lead the party astray vs sensible centre tories. Well, if the sensible lot can do nothing but ape labour shibboleths, nothing will change except the names on the door, and nulab will still be in power. Reform of the NHS is not about left or right wing, it's about finding the best system and implementing it, if necessary in the face of vested interests.
Edward McLaughlin
August 14th, 2009 10:28pm Report this comment"equitable access to healthcare is a pretty good thing."
Better than that, a very good thing, as long as we remember that, as it is funded by a select group, it should be equitable amongst that group only.
Our problem in large part, stems from the fact that the services of our health system are available to people who have not contributed to its funding.
Hysteria
August 15th, 2009 12:26am Report this commentwhat Rhoda and Edward said
Sue
August 15th, 2009 3:04am Report this commentWhen comparing life expectancy from diagnosis between countries, you should take account of other factors, besides the cost, or even quality of care.
For example, the standard annual leave allowance in the US is 5 to 10 working days per year; most people (except the military and government employees) only get 4 federal holidays a year; and sick leave allowance may be between 4 and 10 days a year. True, in the US, some employers offer short-term and long-term disability but it soon gets used up, and FMLA is mostly about keeping your job open - which is useless if you die.
Bottom line, if you have to work throughout a serious, potentially fatal illness, no matter how costly the treatment, your survivability prospects going to be damaged.
Puzzled
August 15th, 2009 7:53am Report this comment"the services of our health system are available to people who have not contributed to its funding": Huh? Given that even children pay VAT on what they eat and drink, smokers pay more than anyone else, and visitors to the UK pay VAT and other taxes while they are in the UK, what people are you referring to? Or do you imagine that income tax is the only tax that matters?
John
August 15th, 2009 11:42am Report this commentCan we please debunk the myth that NHS ia available to all? The homeless cannot register with a GP Practice without a proof of address residence. They have to rely on A and E departments or charities.
The mealy mouthed platitudes of politicians is sickening. That the media does not bring these sleaze balls to task about this reflects poorly on them. If there are any reporters in the house that are not invertebrates, could they please stand up!
http://www.civitas.org.uk/wordpress/?p=984
Edward McLaughlin
August 15th, 2009 1:55pm Report this commentPuzzled.
I'm talking about those who fly in, have their operation under the name of one of their family members or friends, and then fly out again - sometimes.
No tax, no NI. Compared with people here, who have contributed heavily for years and are told to wait in the queue.
Thus we, the UK workers and taxpayers, are trying to fill a bucket with holes in it.
Edward McLaughlin
August 15th, 2009 5:51pm Report this commentPuzzled & John
I will try once again to breach the fence.
It is no myth that those who do not help to fund the NHS, have access to its services.
You fly to UK, you are met by your friends or relatives as arranged.
You stay with them at their address and you go to the doctor posing as a UK resident - ID is not challenged.
You get a date for the hospital and join the rest of those waiting for whatever treatment you require. The only difference is that you will have an interpreter with you at every stage - earning £25 per hour minimum.
I have witnessed this and it is this simple.
Mike Moore
July 12th, 2011 3:50pm Report this commentAmericans believe thay have the worlds best health care for two reasons. 1, They pay for it, unfortunately they pay far far more than is justified by the quality of the care they recieve. 2, They are told over and over again that it is the best. The brainwashing they are subjected to overwhelming. Most Americans believe they could NEVER be brainwashed by their own govt. Regardless of what they believe it is nevertheless true.
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