Kate Andrews Kate Andrews

The NHS has never been the ‘envy of the world’

Usually when the Commonwealth Fund releases its ‘Mirror, Mirror’ study of healthcare systems, it makes waves across the UK media. You might not recognise the formal title of the study, but you’ll be familiar with its findings: this outlier research tends to rank the UK National Health Service as one of the best healthcare systems in the developed world.

It’s a hallowed report for much of the UK medical community and commentariat, reaffirming their unquestioning devotion to the NHS as a truly unique system and the ‘envy of the world’. While other healthcare assessments – from the OECD, European Health Consumer Index, and World Health Organisation, to name a few – often set out the NHS’s shortcomings, the Commonwealth Fund study usually acts as a counterbalance. Uncomfortable truths about the health service can then be swept under the rug by those who are inclined to worship at the NHS’s altar.

The report dropped last night, yet today’s response, compared to most years, has been much quieter. This is perhaps because the report’s findings suggest there may be new countries to envy: in the past four years since the last report was released, the NHS has dropped from ranking first overall to fourth, falling behind Norway, the Netherlands and Australia.

The system has been failing patients for far longer than the headlines suggest

Before we analyse the findings, it’s important to note how the research works. The Commonwealth Fund is fairly open about its preference for more centralised systems, like the NHS, which is why it uses ‘equity’ as one of its five major domains for assessing each system. Its goal is to reform healthcare Stateside, which explains why the major criticisms of the report are aimed at America – predominantly its high spending on healthcare, coupled with its unremarkable outcomes. It’s an argument that isn’t remotely controversial outside of the US, where every developed country offers some version of universal access to healthcare.

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