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A UK Perspective on the 2013 Commonwealth Fund International Survey. Peter C. Smith Emeritus Professor of Health Policy, Imperial College Business School Honorary Professor of Health Economics, University of York peter.smith@imperial.ac.uk. Key findings for the UK.
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A UK Perspective on the 2013 Commonwealth Fund International Survey Peter C. Smith Emeritus Professor of Health Policy, Imperial College Business School Honorary Professor of Health Economics, University of York peter.smith@imperial.ac.uk
Key findings for the UK • Popular support for the UK health system remains very strong (1st out of 11) • Cost-related barriers to access remain very low (1st out of 11) • Physical access (waiting times, out-of-hours, e-mail) consistently better than the median ... while spending is low (10th out of 11)
Context since 2010 • Severe squeeze on publicly funded health expenditure after years of substantial growth • Major administrative reorganization of local strategic purchasing and other regulatory arrangements in England • A high-profile scandal (mid-Staffordshire hospital) exposing serious weaknesses in compassion and quality of care • Efforts to diversify the market in providers of healthcare in England.
Percentage responding: “On the whole, the system works pretty well and only minor changes are necessary to make it work better”, 2001-2013 Source: Commonwealth Fund International Health Policy Surveys, 2001-2013
Health Expenditure per capita, $US constant prices Source: OECD Health Data 2013
In this light, the results of the 2013 Survey are reassuring • Popular support for the National Health Service remains high. • Waiting times for most aspects of care remain at historically low levels. • Out-of-hours access remains relatively good. • Protection from the personal costs of healthcare, and from insurance bureaucracy, remains exceptionally strong. • While expenditure remains low relative to the other countries surveyed.
Quality Watch • Initiative by the Nuffield Trust and Health Foundation to undertake an independent audit of quality trends in England in the light of expenditure squeeze. • Generally positive findings, though some concerns relating to unnecessary hospital admissions and resource pressures in emergency care. http://www.qualitywatch.org.uk/
There are nevertheless serious areas of concern for the future • It is very hard to see how the current benefits package can be sustained in the medium term, given the very challenging limitations on funding currently budgeted for the NHS • The scope for productivity gains is limited, at least in the short term. • Without further tax contributions, possible responses include: reduced scope of treatments covered; introduction of cost sharing; increased waiting times; or other quality reductions • Any of these outcomes may have serious consequences for NHS performance and popular support. • The Commonwealth Fund Surveys will be invaluable references for tracking future trends.