Henry Featherstone

Who has the world’s best healthcare system: the US or the UK? Neither

Who has the world's best healthcare system: the US or the UK? Neither
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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.