Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: 0%; Total: 100%

*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

Current Health Expenditure Per Capita In US$ (2019): $4,313

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

Out-Of-Pocket Expenditure Per Capita In US$ (2019): $736.4

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure (2019): 17.07%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed July 26, 2022.

Household out-of-pocket payment in current US$ per capita (2019): $685

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed August 31, 2022.

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 2.6%

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

“Coverage is universal. All those “ordinarily resident” in England are automatically entitled to NHS care, largely free at the point of use, as are nonresidents with a European Health Insurance Card. For other people, such as non-European visitors or undocumented immigrants, only treatment in an emergency department and for certain infectious diseases is free.⁴

“Private health insurance: In 2015, an estimated 10.5 percent of the U.K. population had private voluntary health insurance, with 3.94 million policies held at the beginning of 2015.⁵ Private insurance offers more rapid and convenient access to care, especially for elective hospital procedures, but most policies exclude mental health, maternity services, emergency care, and general practice.⁶ Data on private insurers are not freely available, but according to the Competition and Markets Authority (2014), four insurers account for 87.5 percent of the market, with small providers making up the rest.⁷

Source: International Health Care System Profiles: Who’s Covered? The Commonwealth Fund. Last accessed Nov. 14, 2019.

“The United Kingdom’s health care system is largely funded by taxes and is mostly free at point of access. Legal residents of the United Kingdom may use the services of the National Health Service (NHS), and they are also free to purchase private health insurance if they wish.”

Source: Cylus J, Richardson E, Findley L, Longley M, O’Neill C, Steel D. United Kingdom: Health system review. Health Systems in Transition, 2015; 17(5): 1–125.

“Inpatient and outpatient services are received free at point of service in most cases, but there are co-payments for prescription drugs that have been growing and amounted to £8.40 per prescription in 2016. These co-payments were capped at £104 annually in 2009 and remain the same today. Furthermore, although the co-payment maximum was lowered in 2006 (from £384 to £189), there have been regular increases since then. Similarly, there are co-payments for dental services (the amount of which varies by service). Both drug and dental co-payments have risen by 2% per year since 2005. Children and students, those age 60 and above, people with specific medical conditions and those on low-income schemes are exempted from co-payments for drugs and dental services, and are covered for vision services (which is normally not covered). Unsurprisingly, the market for VHI [Voluntary Health Insurance] is rather small. Individuals buy VHI to avoid waiting lists, have some choice over the physician they visit, and for more comfortable rooms [15].”

Source: Rice, Thomas et al. “Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries.” BMC health services research vol. 18,1 371. 18 May. 2018, doi:10.1186/s12913-018-3185-8.

“Costs in the NHS are constrained by a global budget that cannot be exceeded, rather than through patient cost-sharing or direct constraints on supply. NHS budgets are set at the national level, usually on a three-year cycle. CCGs are allocated funds by NHS England, which closely monitors their financial performance to prevent overspending. They are expected to achieve a balanced budget each year.

“Since 2010, the allocation of funds by the central government has grown much more slowly than the long-term historical rate, which averaged 4 percent in real terms between 1949–1950 and 2010–2011.³² Between 2010–2011 and 2014–2015, average real-term growth in spending on health rose by 1.2 percent and is projected to rise by 1.1 percent between 2015–2016 and 2020–2021.³³

“The mismatch between funding, demand, and the cost of providing services has led to NHS hospitals and other providers recording a deficit of GBP3.7 billion (USD5.3 billion) for 2015–2016 and a projected gap of GBP6.0 billion (USD8.7 billion) by 2020–2021, even if hospitals can continue to create efficiencies of 2 percent a year.³⁴

“Although some of the savings targets have been met in the past five years, the financial pressure on the NHS is being associated with some deterioration in the quality of care—notably waiting time targets.³⁵

“Cost-containment strategies to date include freezing staff pay increases, supporting the increased use of generic drugs, reducing DRG payments for hospital activity, managing demand, and reducing administration costs. In 2016, NHS Improvement launched a program to help hospital providers generate savings through more efficient use of staff, more cost-effective purchasing of drugs and medical equipment, and better management of estates and facilities, which, if implemented, could save GBP5.0 billion (USD7.2 billion) by 2020.³⁶ There are a number of tools whereby local purchasers can maximize value by addressing unwarranted variations in utilization and clinical practice, provided by the government-funded Rightcare program. Local purchasers can also run competitive tenders for certain services.

“The costs of prescription (branded) drugs are contained by the Pharmaceutical Price Regulation Scheme. The latest scheme, lasting five years through 2018, regulates the profits that drug companies can make selling drugs to the NHS. It is a voluntary scheme, negotiated between the U.K. government and the pharmaceutical industry, with new medicines to be introduced to the NHS at prices set by the manufacturer as long as they remain within the profit cap.³⁷ This scheme runs parallel with the cost-effectiveness appraisals by NICE, which tends not to recommend new drugs as cost-effective if they exceed GBP20,000–GBP30,000 (USD28,900–USD43,350) per Quality Adjusted Life Year (QALY).”

Source: Commonwealth Fund. International Health Care System Profiles: England. Last accessed Jan. 22, 2020.

“Purchasing of health services varies only somewhat across the United Kingdom. In Northern Ireland the Health and Social Care Board negotiates contracts with Health and Social Care trusts. Wales uses a capitation-based mechanism, and local health boards manage the funds they use in delivering services.

“Boards manage their own funds in Scotland, which includes reimbursing primary care contractors for services they provide to the NHS, paying for services provided by the independent sector, and transferring resources to local authorities to assist in the funding of community care. The NHS Scotland Resource Allocation Committee recommended changes to the Arbuthnott allocation formula in 2007. These changes, implemented in 2009/2010, institute a more sophisticated capitation-based allocation system, taking better account of the needs of the elderly and the very young, and of those living in deprived areas (Steel & Cylus, 2012).

“Payment by Results (PbR) in England
“In 2002 the government introduced the idea of a national tariff on hospital activity in England. Until that point, commissioners paid hospitals in block contracts. These contracts did not take into account how much activity hospitals actually saw, or what type of health issues they treated, whereas the new tariff would do that. In 2003 the Payment by Results tariff system was put into place. The system started with some elective inpatient procedures, and has since expanded to include much acute care, covering about 60% of the activity in an average hospital (Marshall, Charlesworth & Hurst, 2014). Hospital stays, from admission to discharge, are assigned to a Healthcare Resource Group (HRG) code; if there are various episodes of care within one hospital stay, the dominant episode is the one coded for. Tariffs are determined by taking national average costs (providers submit their own costs), adjusting Health systems in transition United Kingdom 57 for changes in costs over time due to factors like technology updates, and finally, adjusting according to the market forces factor (MFF), which factors in differences in costs by location. All operations commissioned under Payment by Results must adhere to the Department of Health Code of Conduct (last updated February 2013) (Department of Health, 2013a).

“The Payment by Results system is meant to make it possible to commission all activity according to a standard tariff, but several types of care have not been included in the Payment by Results system so far, notably mental health, critical care and community health care, as well as ambulance services. Some critics argue that the tariffs do not accurately reflect hospital costs, and some commissioners use fixed block contracts rather than payment by results to allocate their funds to public providers to keep those providers financially viable. Additionally, in 2015 many NHS providers protested about the planned tariffs for the following year because of concerns that the proposed price reductions were unsustainable; despite some progress in negotiations, at the time of publication no formal tariff was in place for 2015/2016.”

Source: Cylus J, Richardson E, Findley L, Longley M, O’Neill C, Steel D. United Kingdom: Health system review. Health Systems in Transition, 2015; 17(5): 1–125.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Sept. 22, 2022 by Doug McVay, Editor.