Impact on Federal Government
- Federal government assumes virtually all functions currently performed by private health insurers.
- Tantamount to Medicare being expanded to cover the entire U.S. population but with option to purchase “gap” coverage through private insurance companies.
NHS Organization
- Centrally administered, but bifurcated into “Primary Care Trusts” and “NHS Trusts” (secondary care, mental health services, and more).
- Primary Care Trusts are primarily responsible for using funds allocated to them by the Department of Health to provide both primary and secondary care.
Impact on States
- In a U.K.-style system, U.S. states would no longer be burdened with the large Medicaid expenses, freeing money for other programs (e.g., education).
- In a U.K.-style system, U.S. states might be tasked with administering certain aspects of a federally funded system.
Impact on Insurers
- Private health insurers relegated to a minor role in providing supplemental insurance coverage to those who can afford it.
Impact on Providers
- Providers (particularly physicians) relieved of some of the costs and stress of “running a business.” For example, no need for large staff to handle coverage differences among many health plans.
- In a U.K.-style system, physicians with very high incomes might see a decline in their incomes, though some relatively low paid physicians (e.g., psychiatrists, GPs) could see increases in their incomes.
Impact on Employers
- In a U.K.-style system, many large U.S. employers would stop providing health coverage, thereby lowering costs that would make them more competitive internationally. Additional funds could be used to increase salaries, expand, or increase returns to shareholders.
- Small employers would be largely unaffected, given that most do not provide health insurance.
Impact on Individuals
- In a U.K.-style system, uninsured and moderate-income U.S. families would gain coverage at little or no cost.
- Upper income earners could see higher wages (owing to lower employer insurance costs) but would also face higher income taxes.
Proponents/Opponents
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| Services (except for certain prescriptions, dentistry, and optician services) are free at the point of use. Proponents say that the population covered under the NHS has outcomes equivalent to those achieved in other systems, at lower cost, and that the lower-income sector of the population is healthier than that under other systems. |
On the downside, critics say, the universal coverage reduces individuals’ healthcare choices. Under the system, too, individuals generally face long waiting times for access to healthcare providers and procedures. On a broader level, critics allege that the system smothers innovation; the likelihood that a novel approach will not be reimbursed is a disincentive to innovation. Health information technology initiatives appear to be behind schedule and over budget; critics say that the systems are likely to threaten patient privacy.
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Key Targets for InvestmentNHS dentistry services are not widely available, thus leaving an opportunity for private providers.
Opportunities exist for the private sector in hospital building and assembling an IT infrastructure.
Notable Feature
- A low payment is standard for prescriptions but given the high cost of certain drugs, this benefit is controversial and has resulted in decisions not to cover certain types of care.
- The National Programme for IT, though a target of criticism, is intended to improve the efficiency and quality of patient care.
- In response to complaints about long waiting lists, an initiative is in place to cap waiting times at 18 weeks.
- The National Institute for Health and Clinical Excellence publishes guidelines for use of drugs, devices, and procedures; this agency thus dictates NHS-delivered healthcare and drug coverage.
Experts' Comments
"Some 55% of UK patients said they had had difficulty getting access to GP care on weekends and nights.
This was worse than Germany, the Netherlands and New Zealand and comes amid mounting criticism of the arrangements within the NHS."
--Commonwealth Fund Study
as reported by BBC
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