The British NHS


Category : Medical Rants

Many physicians still clamor for universal health care in the US. We must look at international models to better guess what such a system would do to our health care. Perhaps we would still have an active private medical care system. Great Britain does. Private health: bigger than NHS!

This week, BBC Radio 4 asked me to do an interview on the origins and growth of the non-state healthcare market. Boning up for it, I was reminded just how significant the independent sector is. It provides 85 percent of the UK’s residential care beds, for example, and 20% of all acute elective surgery – that’s the stuff like hip replacements that isn’t exactly life-threatening, but which you want to get done fast anyway.

Indeed, the independent sector has more beds than the NHS and local-authority care homes put together!

It employs almost as many people – roughly 750,000 of them – and it accounts for a quarter of UK health and social care spending. In addition to the 15,000 nursing and residential care homes that the sector provides, private agencies care for more than 200,000 people in their own homes.

Another thing which people don’t realize is the huge contribution of the private sector in mental health and dealing with drug abuse. Indeed, around half of Britain’s medium-secure mental healthcare places are provided privately, in more than 200 private hospitals and units. The sector accounts for 80 percent of all rehabilitative brain-injury beds. Nearly all (96 percent) of NHS-funded in-patient child and adolescent mental health services are provided privately.

On the funding side, almost 7 million people have private medical insurance, while 6 million are members of health cash benefit plans – schemes which pay you cash when you are in hospital. Around 3.5 million trade union members (that’s more than half the total membership) have some kind of private health cover.

Thanks to the blog author for the “heads up”.

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Comments (1)

There’s a little cheating going on here. Most of what the author is talking about is what’s called long term care in the US. That is funded by a mix of public (Medicaid) and private (mostly cash) sources here, but provided almost entirely by private sector facilities (including for-profit ones). That’s similar to the UK other than the money comes more from the state. In the UK, private provision of standard health services is used mostly as a safety valve so that middle and upper income people can get around the queue for NHS surgery. That’s been around forever, as allowing specialists to see private patients was part of the deal cut in 1945 by which they agreed to support the introduction of the NHS. NHS surgeons in specialties like orthopedics or gynecology can (quite legally) double or triple their incomes doing private work on the side.

But in the US context this is all misleading. Not even the most radical single-payer advocate believes that the government should provide all health care, they just think that it should pay for it. What this post ignores is that the every country apart from the US provides some kind of universal system of payment for care, ususally delivered in a mixed public/private system. In virtually all of those countries you can “trade-up” with your own money to get better amenities or jump the queue in the public system.