A UK Perspective on the 2013 Commonwealth Fund International Survey

Peter C. SmithEmeritus 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

0

10

20

30

40

50

60

70

2001 2004 2007 2010 2013

AUS

CAN

FR

GER

NL

NZ

NOR

SWE

SWI

UK

USA

Source: Commonwealth Fund International Health Policy Surveys, 2001-2013

Health Expenditure per capita, $US constant prices

0

1000

2000

3000

4000

5000

6000

7000

8000

9000Australia

Canada

France

Germany

Netherlands

New Zealand

Norway

Sweden

Switzerland

United Kingdom

United States

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.