Great Britain Health System

By Aditya Sood, Aasim Riyaz Khan,Achint Kumar

Post Graduate Diploma In Health Management at Institute of Health Management Research, Jaipur , India

•Total Population=62.6 million

•Urban Population (%)=80

•Population Growth Rate(%)=0.5

•Total Fertility Rate=1.9

•Crude Death Rate(Per 1000 population)=10

•Crude Birth Rate(Per 1000 Population)=12

Source=World Bank Data 2011

Health Indicators

• U5 Mortality Rate(1000)=5 per thousand live births

• MMR=12 per lakh live births

• IMR=4 per thousand live births

• Life Expectancy at Birth -80

• Male- 78.3

• Female-82.5

• Health expenditure per capita = US $ 3,503

Manpower in health Infrastructure• Medical and dental staff- 187/100000 population• Nursing and mid wife staff-786/100000 population• Hospital beds- 33/10000 population• Nearly 1.3 million people are employed in NHS hospital

community service in GB• In 2009 there were over 117,000 medical and dental staff and

over 507,000 nursing and midwifery staff working in hospital

and community health services in the GB• In addition, there were over 302,000, 184,000, and 154,000,

administration and clerical, professional and technical, and

domestic ancillary staff respectively working in hospital and

community health services in the GB in 2009.

Source( OHE Guide to UK Health and Health Care Statistics, July 2011)

HEALTHCARE EXPENDITURE

According to World bank Data, Health (2011), Great Britain is spending 9.6% of its GDP on health.

2007 2008 2009 20107.5

8

8.5

9

9.5

10

8.4

8.9

9.89.6

YEAR

PERC

ENTA

GE

Categories of Great Britain healthcare expenditure

Category 1Publicly funded healthcare expenditure scheme-National Health Service(NHS).

2007 2008 2009 201079

81

83

85

81.382.4

84.1 83.9

Health expenditure, public (% of total health expendit-ure),Great Britain, 2007-2010 , World Bank Data, Health

(2011)

YEAR

PERC

ENTA

GE

Category 2Private Health Expenditure.• It is 16% of the total Health Expenditure.• Out of Pocket expenditure as percentage of private

expenditure on health is 62%

2007 2008 2009 201061.98

62

62.02

62.04 62.04

6262

62

OUT OF POCKET EXPENDITURE (World Bank Data, Health 2011)

YEAR

PERC

ENTA

GE

Category 3Private Health Insurance• Accounts for 2 % of the total Health Expenditure.• Around 12 % of Great Britain citizens are covered by private

health insurance

2007 2008 2009 20103200

3400

3600

3800

4000 38813801

3440 3503

PER CAPITA HEALTH EXPENDITURE ON HEALTH IN Great Britain$, 2007-2010,World Bank Data, Health

2011

YEARPER

CAPI

TA H

EALT

H E

XPEN

-D

ITU

RE U

S$

NATIONAL HEALTH SERVICE

• Launched on 5th July 1948.• Due to financial burden Prescription charge was introduced in

1952,which was abolished in 1962 but re-introduce again in 1968.

• The NHS Health and Social Care Act 2012 sets out a large-scale program for reform to be implemented by the end of 2014.

• Major aim of reform is decentralization. NHS Commissioning Board will be established which will be independent from the day to day control of Secretary of state.

NHS Aims:• To provide medical care free at point of use• To rich and poor alike• in accordance with medical need

2 beliefs:• Those who need care will come forward• Those who provide care know what is required and

how to provide it

FUNDED BY

General taxation 76%National Insurance contributions 19%User charges 5%(G.B. department of Health, 2010)

** Apart from these, NHS earns from prescription of drugs & dental treatments to general population.

COVERAGEIt is universal, all those who are resident or citizens of the Great Britain are entitled to health care. Only treatment in an emergency department and for certain infectious diseases is free to people not ordinarily resident, such as visitors or illegal immigrants.

SERVICES OFFERED• Preventive • Inpatient & Outpatient

• Inpatient & Outpatient drugs

• Dental care, mental health care

• Disabilities & rehabilitation

• Hospital care

• Physician

COST SHARING

• Out patient prescription drugs are subject to a copayment currently US$12.23 per prescription, drugs prescribed in NHS hospitals are free.

• NHS Dental services are subject to copayment of upto US $ 334/ per course of treatment

• Discount through pre payment certificates-people using large amount of prescription drugs.

• Transport costs to and fro from provider sites-low income group people.

People exempted from prescription drug co-payments

Citizens of GB < 16 years of age.

Citizens of GB > 60 years of age

Low income groups

Pregnant women

Those in fulltime education aged 16, 17, or 18.

Those who had a baby in the last 12 months

STRUCTURE

Secretary of State

Department of HealthNHSE

Regional Offices

Strategic Health Authorities

Primary care groups

NHS trusts

Local authorities

TYPES OF HEALTH

SERVICES IN Great Britain

PRIMARY CARE SECONDARY CARE

TYPES OF TRUSTS

Primary care

GPsDentist

Pharmacist

OpticiansNHS direct

NHS walk in centres

Acute Care

Mental HealthAmbulance

NHS Foundation

PRIVATE HEALTHCARE

Private Health Insurance

Private Hospitals

Out of Pocket Expenditure

REGULATORY BODIES

• National Institute of Clinical Excellence publishes guidelines for healthcare professionalsPrivate hospitals do not have to follow these

• Healthcare CommissionMonitoring Healthcare standards and efficiencyResponsible for publishing NHS performance ratings

and indicators

KEY CHALLENGES

• Coronary heart diseases and stroke continue to be leading cause of death in UK

• Approximately 1 in 6 of all deaths in the UK in 2008 were due to coronary heart disease.

• Deaths from strokes accounted for 1 in 14 of all UK deaths.• Crude death rate from liver disease and diabetes continue to rise• Rising alcohol related hospital admissions and alcohol related

deaths• Prevalence of adult obesity in Great Britain is highest in the EU

( OHE Guide to UK Health and Health Care Statistics, July 2011)

• Rising demand and treatment cost• Long waiting periods for elective surgeries• Variations in quality of care across Great

Britain• Lack of accountability of trusts and Primary

Care centers.• Economic downturn in the country• Lack of control by central regulatory bodies

over private healthcare.