Two Ships Passing in the Night

Achieving a High-Performance Health Care System with Universal Access

As the debate about the future of the NHS continues in the UK, the Americans had begun to look at adapting some of the features of Bevan's NHS in order to improve the delivery, coverage and access of healthcare for all Americans since 2008.

This has manifested itself in a not very well known nor well publicised position paper by the American College of Physicians, which was published in the Annals of Internal Medicine in 2008 entitled

"Achieving a High-Performance Health Care System with Universal
Access: What the United States Can Learn from Other Countries

(January 1, 2008; vol. 148, no. 1:55-75) (PDF)

The paper looked in detail at three aspects of healthcare in the US:

  1. Access
  2. Quality
  3. Efficiency

It describes the current healthcare system in the US, compares it with those from 12 other industrialised countries and lists what can be learnt from these systems.

The statistics makes very interesting reading and reveals how efficient the British National Health Service truly is.

For example,in 2005 the US spends USD $6697 per person annually for health care. This is 3 times more than that for Britain. Despite this, the life expectancy is still higher for British people and the infant mortality per 1000 birth is still lower.

Total health care cost for the same year in the US was close to USD $2 Trillion (USD $2.5 Trillion in 2009 and rising). About half comes from federal funds, 35% from private insurance and 13.2% from individuals savings (USD $379 Billion for 2005).

This is staggering as the out-of-pocket healthcare expenses that Americans pay would be almost sufficient to fund the total NHS budget for 2011 ( about £100 Billion).

This is not withstanding the fact that in 2006, 15% or about 47 million Americans were uninsured for at least a year (further 16 million under-insured) while the NHS provides cradle to grave universal care for all 60 million (2010 estimates) British people, which include Acute, Primary, Secondary, Tertiary and follow-up care in the community, all free at the point of care.

In addition, all major healthcare institutions in the UK used to belong to the NHS.

In addition, the costs of administrating the complex healthcare system is more than 2X that of the NHS, and the American suffers from a lack of Primary physicians in the community, unlike UK where the GPs are the backbone of the NHS.

Due to the existence of the NHS which is singularly funded, the supply of medical workforce can be finely tuned and training provided by the state to match the needs of the British population as the trained doctors then remains in the national health service unlike in the States.

Although generally assumed otherwise, only 26% of Primary physicians in the US have extensive clinical information systems in 2006. This compares with the 79-92% in Australia, New Zealand and the United Kingdom.

The American College of Physicians then proceeds to examine and offer a series of recommendation to achieve a high performing system in the US. They humbly conclude with the following statement:

" The main lesson of this article is that many countries have better functioning, lower cost health care systems that out-perform the United States.

We must learn from them."

As the current British government rushes headlong into the fog and darkness, inevitably dismantling and destroying the very qualities and organised structure that countries like the United States are currently trying to emulate and apply, it makes this paper essential reading and study for all stakeholders in the National Health Service.

Access is free

Two ships passing in the night, and it will take every effort by all of us to make sure that the NHS does not run aground in the trecherous seas that she finds herself in the midst of right now !!!

Thank you.

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Page Updated: 27 May, 2017


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