Assignment- Health insurance

1. Managed care in the United Kingdom
UK Healthcare System Overview
-Group 12
IIHMR- Bangalore 2020-22

2. ● Ms Ritapa- Introduction
● Ms Pallavi- NHS in UK
● Dr Siri charan- Private insurance
● Ms Shipra- Challenges of NHS
● Ms Priya Kumari- Comparison with Indian healthcare
● Dr Kritika- learnings and conclusion

3. Country profile and introduction to NHS
The United Kingdom is a sovereign state located off the north-western coast of Europe. The
country includes the island of Great Britain, the north-eastern part of the island of Ireland and
many smaller islands. It has a population of 62,262,000 people and a reported GDP of $2.260
trillion Great Britain Pounds.
The United Kingdom provides public healthcare to all permanent residents, about 58 million
people.Healthcare coverage is free at the point of need, and is paid for by general taxation.
About 18% of a citizen’s income tax goes towards healthcare, which is about 4.5% of the
average citizen’s income. Overall, around 8.4 percent of the UK's gross domestic product is
spent on healthcare (an amount of around 0.18984 trillion GBP). UK also has a growing
private healthcare sector that is still much smaller than the public sector.
The National Health Service (NHS) was founded in 1946, and is responsible for the public
healthcare sector of the UK.

4. Healthcare situation
In the United Kingdom
The UK's health care system is one of the
most efficient in the world, according to a
study of seven industrialized countries.
The Commonwealth Fund report looked at
five areas of performance - quality,
efficiency, access to care, equity and healthy
lives, The Netherlands ranked first overall,
closely followed by the UK and Australia.
UK performed well when it came to quality
of care and access to care.
The UK also ranked first in efficiency, which
was measured by examining total national
spending on healthcare as a percentage of
GDP, as well as the amount spent on
healthcare administration and insurance.

5. Burden Of Disease
● Premature Deaths-A striking
finding from the report is that on a
day to day basis, the most common
causes of burden for people are back
pain, poor mental health, skin
conditions.
● Unhealthy Lifestyle- It is reported
that the death occurred due to
tobacco that is 10.7% in all over UK.
Unhealthy diet is also a large
contributor and the percentage
is 10.8% of total disease burden.

6. Health Care Status
Mortality Indicator
Life Expectancy
Crude Death Rate
Mortality Indicator:
For Cardiovascular Diseases-25%
For Cancers-28%
Chronic Respiratory Diseases-8%
Diabetes-1%
Other NCDs-26%
Communicable Disease: 8%

7. Health Care Status
Contd…..
Life Expectancy
Life Expectancy at Birth in UK in 2017-
2019 was 79.4 years for males and 83.1
for females.
In 2016-2018 the life expectancy at birth
in Uk was for male 78.2 years and for
female 82.5 years.

8. Health Care Status
Contd...
Crude Death Rate

9. NHS
The UK healthcare system, National Health Service (NHS), came into existence in the aftermath
of the Second World War and became operational on the 5th July 1946.
The NHS is the largest employer in the UK with over 1.3 million staff and a budget of over £90
billion.
The National Health Service (NHS) is the publicly funded healthcare system in England, and
one of the four National Health Service systems in the United Kingdom. Primarily funded by
the government from general taxation, and overseen by the Department of Health and Social
Care, the NHS provides healthcare to all legal residents of the UK, with most services free at
the point of use. Some services, such as emergency treatment and treatment of infectious
diseases, are free for most people, including visitors.

10. Organisational
Structure

11. NHS
Healthcare in UK is provided by the National Health Service and provides treatment to all
permanent residents. After the Second World War, an endeavour was undertaken to launch a
public healthcare system in which services were provided free at the point of need, services were
financed from taxation and everyone was eligible for care.
The British Government
Taxes
Healthcare
Healthcare is provided by the British Govt. which is paid for through taxes. Most services are free
but some services are charged at NHS rates.

12. NHS SERVICES
GP SERVICES
HOSPITAL SERVICES
EMERGENCY
MENTAL HEALTH
SEXUAL HEALTH
SOCIAL CARE
DENTAL SERVICES
EYE CARE
PRESCRIPTIONS
FREE OF COST PAID SERVICES AT NHS RATES
Care for older people
Care for disabled people
SPECIAL NEEDS SERVICES

13. Eligibility and registration for NHS
Eligibility:
Intend to live there permanently and need to be there for 6 months to be eligible.
Their passport allows them to stay there for at least 1 year without any restrictions and the same
applies to their family.
Registration:
Visit a General Practitioner
Complete and submit the form
Receive NHS card and No. through post

14. RECEIVING CARE FROM NHS
Primary care providers
(General Practitioners)
Secondary care providers
(Specialists)
The first point of contact is the Primary care
providers, primary care providers determine
whether the patient requires further treatment
and refer them to the specialists.
A referral letter is necessary for the patients to
see a specialist and it comprises of their medical
history and background.
In UK the patient has the right to see a specialist
within 18 weeks from the referral date. (Excludes
maternity and some mental health services)
Referral

15. REGISTRATION ISSUES
1. Not eligible for NHS healthcare in UK.
2. GP practice is not accepting new patients.
3. The patient lives outside of GP practice area.
Patient Choice Scheme:
Most GP Practices are strict with their practice boundaries and do not accept patients from outside
but some GP Practices allow patients to register in an area that is convenient for them, this is known
as the patient choice scheme.

16. URGENT ASSISTANCE BY NHS
1. NHS walk-in-centres
2. Services provided out of hours
3. Minor injuries unit
4. NHS - 111
Care Quality Commission:
Conducts safety and quality inspections of all health and social care providers.

18. Private health insurance
Depending on the level of your cover it can be used to
pay for everything from private hospital stays to
surgeries, private room stays to physiotherapies,
diagnostic services to much more
The market for private healthcare services is
projected to reach USD 13.8 billion by 2025 due to
the rise in NHS waiting times and referrals to the
private sector.
According to the data published by the Association
of British Insurers (ABI), 1.7 million people in the
United Kingdom had private medical insurance
(PMI)
Policy that covers the cost of private health care

19. Why Private Insurance?
Free Public NHS + Private medical insurance gives
Faster Appointments and faster diagnosis
Choice of Care
Stay in Private insured hospital rooms
Assess drugs and therapies not available with NHS
Gain access to top specialists and consultants
What else from NHS?
Virtual General Practitioner Appointments
Complementary Therapies
Mental health Support
Dental and optical cover

20. How Private Insurance Works?

21. Basic
or treatment only
covers the cost of any
treatment you need
while you’re in
hospital, as well as the
cost of your stay.
What do plans cover?
Medium
or treatment and
limited diagnosis
covers treatment, as
well as some
diagnostic testing.
Comprehensive
or treatment and full
diagnosis covers all
your treatment,
including any
diagnostic testing you
undergo at private
facilities.
The private insurance has two main components: Treatment and Diagnosis

22. TOP PROVIDERS OF HEALTH INSURANCE PLANS IN UK
This is the largest insurance company in UK, it is a global brand that
service about 32 million customers around the world. It usually offers a
free month for new customers, regular customers have also some
benefits regarding changing options of the policy to reduce the premium
cost plus the 25% off discount on gym memberships.
This is one of the largest companies in UK that provide medical insurance policies.
It allows its policyholders to determine the time they need for treatment in the case
of illness. Furthermore, there is a helpline that operates 24/7 and is ready to help
you with any query regarding your health issues. It also provides tips about doing
exercise and staying fit.

23. Bupa is a very large UK health insurance company that owns a network of private clinics
and hospitals. It covers a wide range of medical services from diagnostics to treatments.
Furthermore, it offers home nursing and private ambulances. Health insurance policies of
Bupa are tailored, that means you may not involve some services such as diagnosis in
order to reduce the cost of insurance.
Such as other health insurance companies, Vitality covers both diagnosing and
treating. In addition to this, it helps customers to maintain their health better by
offering discounts on active gym. It also tracks the health of their customers and
rewards those who become healthier by offering discounts.
TOP PROVIDERS OF HEALTH INSURANCE PLANS IN UK

25. Top European Private Health Insurers

26. Advantages and disadvantages
Specialist referrals
Get the scans you want
Reduce the waiting time
Choose your surgeon and hospital
Specialist drugs and treatments might
be available
You might get better care on the NHS
Private medical insurance is expensive
Chronic illnesses aren’t usually covered
Pre-existing medical conditions aren’t
usually covered.
Advantages Disadvantages

27. CHALLENGES OF NHS
● Beneficiary has no freedom to choose their doctor.
● Even for investigation approval is mandatory.
● Future pressures on the NHS from changing
demographics-
○ The ageing of the population.
○ Healthcare costs and age.
○ Demographic change and its impact on health spending
○ Future patterns of disability and illness: health expectancy

29. India UK
Population 1.3 billion 6.6 million
Healthcare delivery system 3 stage NHS
% of GDP spent on
Healthcare
4% (Govt 1.7%) 9% (7.6%)
Healthcare spending per
person
RS 1,657 RS 3,23,625
Healthcare providers Doctors, nurses, mid-wives,
specialists, physicians,
ayush doctors, etc
General practitioners (who
assess and then may refer
to a specialist)
Regulatory body CDSCO (MOHFW) CQC
Life expectancy 70.08 years 81.52 years

30. India UK
Hospital beds/1000
population
0.5% 2.5%
Doctor-patient ratio 1.34% per 1000 people 2.8% per 1000 people
Leading causes of death Coronary heart disease Ischaemic heart diseases
Prevalent Communicable
Diseases
Tuberculosis and Malaria Flu and Measles
Freedom to choose doctor Yes No (Registered GP)
Investigations & diagnostics Anytime Not without approval or
urgent need
OTC Medications Available Unavailable

31. Inspiration for India
Population
GDP
Healthcare facilities
Access to clean water and sanitation
Payment to doctors
Burden of disease
Life expectancy

32. Conclusion
The NHS is a residence-based rather than an insurance-based system.
NHS healthcare is funded mostly through direct taxation.
The local general practitioner (GP) is the first point of contact for most medical
situations aside from emergencies. They can provide assessments and advice
for most illnesses and complaints, prescribing medication, or referring to a
specialist if necessary.

33. References
● Google scholar
● Pubmed
● NCBI
● OHE
● WHO
● World Bank
● Youtube
● Commonwealthfund.org
● nhs.uk