NHS vs. U.S. Healthcare: Public vs. Private Models Compared

Introduction to Healthcare Systems

The National Health Service, Britain's centralized universal healthcare system, has grown to become the world's largest publicly funded health service, providing one of the most well-organized, democratic, and comprehensive services available to the citizens of the United Kingdom. Globally, many countries follow Britain's healthcare model. However, the United States employs a different approach. As the United States creates policies reflecting traditional capitalistic ideals, it maintains a privatized healthcare system. Public and privatized healthcare systems are significantly influenced by underlying cultural understandings about the right to access health services, which differ from country to country.

In order to create an appropriate and comparative analysis between these two models, one must examine their expenditures, health status characteristics according to demographics, availability of services, and the problems each system faces. These factors reveal how fundamental philosophical differences about healthcare—whether it is a right or a commodity—shape outcomes for citizens and their access to treatment.

NHS Structure and Funding

The National Health Service was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth—a principle that remains at its core. Healthcare is provided by a single payer, the British government, and is funded by the taxpayer. All appointments and treatments are free to the patient, though paid for through taxes, as are almost all prescription drugs. Providing healthcare services where the citizen does not have to worry about the cost of treatment, testing, appointments, and prescription medications relieves significant stress from the population. This helps ensure that preventable illnesses, diseases, and deaths are prevented or do not spread to the broader population.

The term expenditure refers to the amount of money spent by a program. The total health expenditure is the sum of public and private health expenditure, making it easier to examine how funds are spent. It covers the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for health, but does not include provision of water and sanitation. The NHS remains free at the point of use for anyone who is a resident in the UK. Funding for the NHS comes directly from taxation and is granted to the Department of Health by Parliament.

Health Demographics and Outcomes

NHS net expenditure (resource plus capital, minus depreciation) has increased significantly from £57.049 billion in 2002/03 to £105.254 billion in 2012/13, with planned expenditure for 2013/14 at £109.956 billion. Approximately 80 percent of NHS funding is allocated to the 151 Primary Care Trusts (PCTs), which are responsible for purchasing health services to meet local need. The remaining 20 percent comprises capital spending and funds distributed to deliver regional and national programs and services.

The National Health Service covers a population of 63,395,574 (July 2013 estimate). Of the estimated population, 17.3 percent are 0–14 years of age, 12.8 percent are 15–24 years of age, 41.1 percent are 25–54 years of age, 11.5 percent are 55–64 years of age, and 17.3 percent are 65 years and over. With 159,779 total deaths in 2009, circulatory diseases are the leading cause of death in the UK. Not far behind, with 140,497 total deaths in 2009, cancers and other neoplasms represent another leading cause of death. The death rate for adults is 9.33 deaths for every 1,000 population. The infant mortality rate is 4.5 deaths out of every 1,000 live births. The infant male mortality rate is 4.93 deaths per 1,000 live births, while the female rate is 4.05 deaths per 1,000 live births.

Britain ranks among the best countries in the world according to quality-of-life measures. The Social Progress Index ranked the UK in 13th place out of 132 countries, ahead of the United States, France, Italy, and Japan, but just behind Germany. However, Britain placed only 37th in terms of health, mainly because approximately a quarter of the population is obese. This information demonstrates that Britain does not have a perfect healthcare method, but they remain substantially ahead of the United States in health outcomes.

Service Availability and Patient Satisfaction

Even though public healthcare can work well for a population as a whole, not everyone's specific needs can be met effectively. Satisfaction with health varies most notably by age in the UK. Two-thirds of people aged 16 to 24 reported that they were somewhat, mostly, or completely satisfied with their general health in 2011–12. This compares with 54.7 percent of those aged 45 to 54, 55.0 percent of those aged 55 to 64, and 53.7 percent of those aged 75 and over. Those aged 45 to 54 and 55 to 64 were more likely to report that they were somewhat, mostly, or completely dissatisfied with their general health at 38.3 percent and 37.3 percent, respectively. While the British people have qualms with the healthcare system, overall the system functions effectively, and the majority of the population is satisfied.

Healthcare is provided by a single payer, the British government, and is funded by the taxpayer. With few exceptions, the NHS remains free at the point of use for anyone who is a resident in the UK. It covers everything from antenatal screening and routine treatments for long-term conditions to transplants, emergency treatment, and end-of-life care. In practice, "free at the point of use" means that anyone legally registered with the system, including UK citizens and legal immigrants, can access the full extent of critical and non-critical medical care without any out-of-pocket payment.

There remain challenges with the National Health Service, particularly regarding access to medical care. In 2010, approximately one-third of England's NHS patients deemed ill enough by their General Practitioner waited more than one month for a specialist appointment. The British Government was compelled to issue England's 2010 "NHS Constitution," in which it was declared that no patient should wait beyond 18 weeks for treatment. When patients need to seek specialist care, they should be able to have appointments made promptly and treatments administered swiftly. Health is something no person, insurance company, or government should withhold or bar from someone in need. The fact remains that the NHS is available to all citizens of Britain.

Quality of Care and Mortality Rates

Quality of medical care reveals mixed results in cross-national comparisons. Breast cancer mortality rates are 88 percent higher in the United Kingdom than in the U.S.; prostate cancer mortality rates are significantly worse in the UK than in the U.S.; mortality rates for colorectal cancer among British men and women are approximately 40 percent higher than in the U.S. Despite these disparities in specific cancer outcomes, approximately six million British citizens purchase private health insurance. Compared to almost two-thirds of British people earning more than $78,700 per year, private insurance remains manageable for those seeking additional options. The cost of private healthcare in countries with a public option is dramatically less than in countries without one. According to reports, the number of people paying for their own private care has increased 20 percent year-over-year, with approximately 250,000 now choosing to pay for private treatment out-of-pocket annually. The British government's provision of a health care system does not preclude the use of private health service companies, giving citizens the choice between public and private options.

In the United States, the cultural understanding of healthcare is based on the idea that working Americans should receive healthcare as compensation for labor that ensures economic and societal success. The most effective system to reflect this mentality couples healthcare with employment. However, this approach allows a substantial number of Americans to fall through the cracks. Americans who are not fortunate enough to receive healthcare through their employer are usually unable to supplement their own coverage, as the cost of healthcare at privatized and premium rates is prohibitively high. Healthcare in the United States is often treated as a luxury that many Americans cannot afford.

The U.S. Healthcare System and Insurance Gaps

In comparison to the United Kingdom, the United States spends a higher portion of its gross domestic product on healthcare every year than any other country. Although the U.S. performs worse on life expectancy and infant mortality, it also leads in deaths deemed "preventable" with acceptable early care and diagnosis. The typical U.S. citizen has far fewer doctor appointments each year than citizens of other countries, yet pays significantly more for the privilege. More recently, the Obama Administration introduced the Affordable Care Act, a government effort to balance the scales between insurance companies and citizens. Politically, this bill has faced controversy due to conservative laissez-faire attitudes toward economics. With the American government debating healthcare solutions, millions of Americans remain without insurance and untreated for ailments they may have.

Approximately 50 million people (more than half of whom are African-American) do not have health insurance. Of those who are insured, at least 25 million are underinsured, declining necessary care because of high deductibles and co-pays. These individuals refrain from visiting hospitals, medical doctors, eye doctors, and dentists simply because care is completely unaffordable. If someone without health insurance visits an emergency room, they may apply for Charity Care. However, not everyone is eligible. Upon discharge from the emergency room, patients receive paperwork requiring them to prove they are poor or unable to pay. Many are declined for this assistance simply because of income levels that, while above official poverty thresholds, are still insufficient to afford treatment. If you have health insurance in the United States, you likely pay extraordinary amounts monthly and substantial co-pays during visits, which further discourages people from seeking care. This financial burden is a primary reason the United States falls far behind most developed countries in health care standards.

Discussing both healthcare structures in the United States and the United Kingdom, it may be concluded that the National Health Service is the superior model. The NHS is available to all citizens, regardless of financial status. While it has shortcomings on which the system is working, every person in the UK has coverage in the event of illness, injury, or death. Strictly following privatized healthcare as the United States does excludes many people from access to care when they need treatment most. Britain was the only country where the majority of doctors felt the quality of healthcare was improving. In contrast to the United States, the NHS rated highly for fast, inexpensive, and readily available care for all citizens.