What the Yanks Could Learn from
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Last updated February 10, 2017

By Louise Carr, Associate Editor and Featured Columnist

Healthcare is on everyone’s mind right now. Obamacare is up
in the air, and Americans are wondering if healthcare will
ever be affordable across the board like it is in the UK,
France and Canada. How do these countries ensure that
healthcare is available to all – often for free? Is it true that
you never have to buy health insurance when you’re a UK

The NHS – the UK’s National Health Service – was set up in
1948 and since then has provided a single payer system for
UK residents. How is this possible? Can the US learn
something from the UK’s universal healthcare coverage?

First Shock -- How Easy It Is to Access Your Health care

Say you are sick in the UK and decide you need to get care.
You simply get yourself to an NHS Clinic, give your name  
and a doctor comes into the room to see you. But wait ---
where are the insurance forms to fill out? Do I have to show
them my insurance card? Where did I put that card anyway.

Relax, there is nothing to hand a doctor. There is no
insurance form to fill out. There is no insurance card to hand
to anyone.

The NHS doctors don't concern themselves with any of that.
They are there simply to get you healthy again. That's it.  
When your treatment is over, you don't have to do anything
but walk out. No bill will arrive at your home two weeks later
demanding that you pay or else.

How Much Does The Average Person Spend on the NHS -
And How Much Does It Cost to Run the NHS?

Treatment on the NHS is free at the point of delivery.  I
repeat, treatment is free at the point at which you receive
your medical care.

This means that the average UK resident should not have to
pay anything for treatment on the NHS.

But, of course, there are some costs involved.  For example,  
prescription drug charges, dental costs, and the cost of
travel to the hospital or the doctor.

Much of this cost can be reclaimed by people on low incomes
through a combination of schemes such as the NHS Low
Income Scheme, Universal Credit, Help with Dental Costs,
Eye Care Entitlement, and help with prescription and help
with travel costs.

While the cost of the NHS is supposed to be free to all, it
goes the other way - everyone costs the NHS, simply by
living in the UK. But not all people "cost" the same. The
Nuffield Trust says that public spending on the NHS reached
£2,069 ($2,500) per person in the UK in 2014-15, but this
varies depending on age, gender, and condition of health.

For example, the Nuffield Trust says that a woman aged
between 25 and 29, who visits a doctor just three times a
year, will cost the NHS £1,058 ($1,330). A man aged
between 60 and 64 who goes to the doctor six times a year
will cost the service £2,205 ($2,770).

Different illnesses and injuries cost more than others. If you
have a heart bypass? That'll be £8,470 ($10,640). A broken
leg? £1,100 ($1,382).

At present, people in the UK do not have to show proof of
their eligibility for free NHS care (i.e. their residency status.)
But the system is open to abuse – a 2016 study from the
National Audit Office found the NHS collected just £255 
million ($320 million) of at least £500 million ($628 million)
spent providing treatment to foreign patients in 2015.

Proposals from the Department of Health are currently being
discussed, which could demand that every patient brings two
forms of ID - for example, a passport and a driving license -
before they can receive healthcare.

What’s the History of the NHS?

The National Health Service was launched on July 5th 1958
by the minister of health of the time, Aneurin Bevan. The
NHS arose from the core belief that good healthcare should
be available to all, regardless of means. The three funding
principles of the NHS are: that the NHS meets the needs of
everyone; that it is free at the point of delivery; and that it is
based on clinical need, and not on the ability to pay.

How is the NHS Structured?

At the top of the tree is the Secretary of State for Health, a
government minister who has responsibility for the work of
the Department of Health. The Department of Health leads
the provision of public health and the work of the NHS. The
NHS is an independent body, removed from the government,
and it sets the priorities and the direction of public
healthcare for the UK population. It commissions the
services the public uses, from doctors to pharmacists and

Today, the NHS in England deals with over one million
patients every 36 hours.

There are 1,5 million people working for the NHS, meaning it
is in the top five of the world’s largest employers that
includes the US Department of Defense, Walmart, McDonald’
s, and the Chinese People’s Liberation Army.

The NHS provides health cover for everything, from routine
checks to transplants, antenatal screening to end-of-life
care. It differs from the healthcare system in the US in that
every UK resident is entitled to healthcare at the point of
delivery, meaning no one should need to buy health

Is the NHS Free?

The guiding principle that healthcare should be available to
all means that most NHS services in the UK are free for all UK
residents. There are some services which are charged, which
include prescription drugs (there is a set charge per
prescription, regardless of what type of drug is prescribed),
optical services, and dental services.

In order to offer free healthcare, the money must come from
somewhere. In the case of the NHS, the money comes from
taxation. Residents of the UK pay for it from their wages.
And it’s a large bill. At its launch in 1948, the NHS had a
budget of £437 million/$544 million (around £15/$19 billion
at today’s value). Today the budget is nearly £116.4/$145

How Effective is the NHS?

The Commonwealth Fund in 2014 said that in comparison
with 10 other healthcare systems – the US, Canada,
Australia, Germany, France, Norway, Sweden, Netherlands,
Switzerland, and New Zealand – the NHS was the best
overall and in terms of effective care, efficiency, and cost-
related issues.

But in recent years the NHS has been criticized for poor
levels of service and poor quality treatment.

A the 2015 Euro Health Consumer Index (ECHI) said that
the NHS is only the 14th-best healthcare system in the whole
of Europe, only just ahead of countries like Croatia, Estonia,
and Slovenia. The best-performing healthcare system was
defined as the Netherlands, then Switzerland, and then

The report says that in too many areas of care, including
survival of patients and the amount of time it takes to wait to
see a doctor, the NHS is delivering “mediocre” results. One
of the reasons why the UK is so low down on the list is due
to the low number of doctors per 100,000 of population.

The researchers do single out the NHS for praise, however,
in some areas such as decreasing the numbers of people
dying from a traffic accident, heart attack, or stroke.
But it remains that people in the UK do not necessarily all
rely on the NHS for all their healthcare needs – increasing
numbers of people are opting for private medical insurance
to beat waiting lists, get treatment faster, access a wider
number of treatment options, and get better service in
hospitals including private rooms and more comfortable

What Can the US Learn from the NHS?

In the Commonwealth Fund 2014 list, the US comes in at
11th out of 11 for healthcare. But the US spends a huge 17
percent of GDP on healthcare – so something is clearly not
going right.

The US is the same as the UK for emergency treatment –
hospitals must treat emergency cases without payment

And, like the UK, many people in the US can access
healthcare for free or for a reduced cost although it is
through a network of public programs like Medicare and
Medicaid, not one overarching provision like the NHS.
But almost every visit to a doctor or a specialist in the US will
result in some co-payment, whether or not there is insurance
involved. Many are struggling in the US to get an affordable
healthcare policy that works for their needs.

While the UK’s NHS is not perfect by any means, and it
comes under increasing strain as budgets are cut and
services are oversubscribed, it does remain free at the point
of delivery – there are no upfront payments.

Americans may  look at this "free" price tag with envy,
although it remains to be seen whether the system of "free"
healthcare for all will continue as governments and priorities
change in the UK and around the world.  

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NHS care is free at the point at which you
receive service.