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  1. 1. The United Kingdom health care system ALTOMARE Alexia OLIVIERI Marie
  2. 2. I. Overview ● Publicly financed ● Largely publicly provided ● Universal coverage for the population with a zero price at the point of consumption for the majority of treatment ● Dominated by the public sector ● Relatively small private sector → specializes in non-emergency surgical procedures .
  3. 3. II. Health Care System ( = HCS ) A. Historical Development ● Comprehensive national health insurance ● NHS = National Health Service => Publicly financed and provided, largely from general taxation ● Clinicians did not challenge the government's funding decisions . ● In exchange → maintained discretion in the use of ressources within the fixed global budget .
  4. 4. B . Financing the UK NHS ● Funded largely from general taxation that covers approximately 86% of the total cost ● National insurance contributions = proportional payroll taxes to individuals and employers → 12% of expenditure and user charges → for dental care and prescribed pharmaceuticals → finances the remaining 2%
  5. 5. ● Dentists now provide only private dental care ● Ophthalmic « privatized » over time ● NHS ressources : fell from 5,3% in 1949 to 0,6% in 1999. ● 1999 , UK spent : - £61 billion on health care - £52 billion on the NHS - £4,4 billion on pharmaceuticals an other products without NHS prescriptions
  6. 6. C. What is purchased with the expenditures ? ● majority of services by the NHS are free at the point of delivery → includes access to all hospital and primary care services ● patients’ access to the health care system tends to be through the general practitioner ( GP ) ● patients can also enter the hospital sector through accident and emergency departments . => GPs provide the majority of primary care services , including practice nurses and sometimes other health professionals such as physiotherapists and counselors
  7. 7. ● Individuals pay for some NHS-provided services ( dentistry and prescriptions ) ● Prescription charges = £6.10 / item Exemption = only 14% of prescriptions are chargeable and so user charges cover only a small proportion of overall NHS costs . ● Exempt people : children , the elderly , people with certain chronic diseases, and people with low incomes receiving state benefits ● Some prescribed items are exempt : oral contraceptives .
  8. 8. D. How do these expenditures reach the providers ● Government decides the total size of the UK NHS budget for each of the four countries . HCHS = Hospital and Community Health Service. ● Population is weighted by age and other determinants of the “ need” for health care resources . ● Primary care budget has demand determined and cash-limited components : it is a function of the number of general practitioners and their prescribing behavior .
  9. 9. ● Relatively low cost of the NHS = result of tight control of expenditure by central government , in comparison to other HCS . ● Salary systems for remuneration of hospital doctors reduce the incentives for overtreatment and supplier-induces demand , which may exist in fee-for-service systems . ● “ gatekeeper ” system = patients enter the HCS via their family General Practitioners (GP) , who care for approximately 90% of all patient episodes in the community → may keep overall costs down .
  10. 10. Remuneration of GPs : - combines a capitation element , a basic practice allowance and some fee-for-service elements . - 60% is paid on a capitation basis and additional payments are also made for individual services . These additional payments include : - Target payments for childhood immunizations - Target payments for cervical cytology - Additional payments for holding health promotion clinics - Fee-for-service elements such as payments for minor surgery and payments for provision of contraceptive services .
  11. 11. Remuneration of hospital doctors : - paid on a salary basis , with fixed salary scales . - majority of consultant also undertake some private practice , with varying levels of remuneration . => payments for medical examinations or other requests from individuals , insurance companies , employers , which are thought to be outside normal duties . - consultants may receive a distinction award , paid in addition to their basic NHS salary .
  12. 12. III. The demand for health care : scarcity and rationing HC demands of individuals , groups, and society axceed the available resources to fund these services . Private HCS → rationing takes place on the basis of ability to pay => price of health care determines its allocation .
  13. 13. Waiting list : - introduced in 1987 - Around 1 million people are on , waiting for hospital therapy → but priority setting must take place . - “urgent” , “soon” , and “routine” indicate priorities within the waiting list . => The numbers of patients on waiting lists in the UK do , however , attract a great deal of political and media attention .
  14. 14. In general , doctors feel happier making clinical rather than economic decisions . Constraints on public funding in the NHS and the gap between demand for HC and supply of HC resources in the UK during 1980s created a public perception of “underfunding” in the H service and were the precursors to the radical NHS reforms of 1991.