2022 health system review in the United Kingdom


In the healthcare delivery system, there are four separate systems

Since devolution in the late 1990s, the respective governments in England, Scotland, Wales, and Northern Ireland have been responsible for organizing and delivering health care services.

United Kingdom residents enjoy access to a National Health Service (NHS) based on clinical need and not the ability to pay. In contrast, free access to social care services is means-tested across countries in the United Kingdom, with different eligibility criteria.

Health infrastructure and doctors are lacking

The United Kingdom has a relatively low level of both doctors and nurses, as well as a low level of hospital beds and diagnostic equipment, compared to other high-income countries. These shortfalls have left the country with little spare capacity and vulnerable to severe shocks like the Covid-19 pandemic. In addition, they have led to growing waiting lists for elective care, with over 6 million people on waiting lists in England alone by 2022.

Financial protection against illness is possible through healthcare financing

Historically, health expenditure in the United Kingdom has undergone cycles of sustained growth and austerity. Despite this, total health expenditure has increased over the past decade, reaching just over 10% of GDP in 2019. The proportion of government funding for health is high and has remained relatively unchanged over the past two decades, at about 80% of total health expenditure. As a result, UK nationals enjoy a high level of protection against the financial consequences of ill health and minimal out-of-pocket payments.

Reforms aim for greater integration of care and cross-sectoral partnerships that improve the health and well-being of local populations.

Several barriers remain across the four countries to facilitate meaningful integration between health care services, such as unlinked health information technology systems, duplication of governance, and lack of strategic planning. Northern Ireland is the only United Kingdom constituent country where the NHS and social care are fully organizationally integrated, although efforts to expand such integration have accelerated in England, Scotland, and Wales in recent years with cross-sectoral partnerships.

The United Kingdom has a National Health Service (NHS) whose access is based on clinical need and not the ability to pay. All persons, regardless of their nationality or immigration status, are entitled to access to free primary, emergency, and compulsory psychiatric care. Coverage for secondary care services, however, is only available to those who are ordinarily residents. Healthcare expenditure was 10.2% of GDP in 2019, the eighth highest in the WHO European Region. Public funding for health (79.5% of health expenditure) is relatively high, and out-of-pocket costs reached 17% in 2019. Private medical insurance is usually used to finance some selected services not offered by the NHS or to access NHS-covered services, Faster service.

Major health reforms in each of the United Kingdom’s constituent countries focused on promoting the integration of care and facilitating cross-sectoral partnerships that improve the health and well-being of local populations. More recently, in England, the NHS is undergoing a structural restructuring, from July 2022, clinical commissioning groups are being replaced with integrated care systems, which will be responsible for providing health and social care services to local populations of 1 to 3 million people. Northern Ireland has also commissioned a consultation on the development of a new planning model to strengthen the delivery of integrated healthcare services.

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Marta Lopez

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By Marta Lopez

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