United Kingdom: health system review 2022 – European Observatory on Health Systems and Policies

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Health Systems in Transition, Vol. 24 No. 1

Four separate health care systems are responsible for delivering health services
Since devolution in the late 1990s, the respective governments in England, Scotland, Wales and Northern Ireland have been responsible for organising and delivering health care services.
United Kingdom residents enjoy access to a National Health Services (NHS) based on clinical need, and not ability to pay. In contrast, free access to social care services is means-tested, with different eligibility criteria across the nations of the United Kingdom.

There are shortages of doctors, nurses and health care infrastructure
The United Kingdom has relatively lower levels of both doctors and nurses, as well as lower levels of hospital beds and of diagnostic equipment, than most other high-income countries. These shortages have left the country with little spare capacity and vulnerable to acute shocks such as the COVID-19 pandemic. Also, they have led to growing waiting lists for elective care, with over 6 million people in England alone on a waiting list in 2022.

Health care financing provides high levels of protection against the financial consequences of ill health
Historically, health spending in the United Kingdom has gone through cycles of sustained growth and austerity. Nevertheless, total health expenditure has increased in the last decade, reaching just over 10% of GDP in 2019. The proportion of public funding for health is high and has remained relatively unchanged over the last two decades, at around 80% of total health spending. Consequently, UK citizens enjoy high levels of protection against the financial consequences of ill health and minimal out-of-pocket payments.

Reforms are targeting greater integration of care and cross-sectoral partnerships that improve the health and well-being of local populations
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