Population, Midyear 2022: 67,508,936
Population Density (Number of Persons per Square Kilometer): 278.11
Life Expectancy at Birth, 2022: 82.16
Infant Mortality Rate, 2022 (per 1,000 live births): 3.21
Under-Five Mortality Rate, 2022 (per 1,000 live births): 3.74
Projected Population, Midyear 2030: 69,175,770
Percentage of Total Population Aged 65 and Older, Midyear 2022: 19.17%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2030: 22.02%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2050: 26.15%
Source: United Nations, Department of Economic and Social Affairs, Population Division (2023). Data Portal, custom data acquired via website. United Nations: New York. Accessed 12 May 2023.
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 As Percentage Of Gross Domestic Product, 2020: 11.98%
Source: Global Health Observatory. Current health expenditure (CHE) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed May 14, 2023.
Current Health Expenditure Per Capita in USD, 2020: $4,927
Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed May 13, 2023.
Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure, 2020: 13.6%
Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed May 13, 2023.
Out-Of-Pocket Expenditure Per Capita in USD, 2020: $670.3
Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed May 13, 2023.
Population, 2021: 67,281,000
Annual Population Growth Rate, 2020-2030 (%): 0.3%
Life Expectancy at Birth, 2021: 81
Share of Urban Population, 2021: 84%
Annual Growth Rate of Urban Population, 2020-2030 (%): 0.5%
Neonatal Mortality Rate, 2021: 3
Infant Mortality Rate, 2021: 4
Under-5 Mortality Rate, 2021: 4
Maternal Mortality Ratio, 2020: 10
Gross Domestic Product Per Capita (Current USD) (2010-2019): $43,103
Share of Household Income (2010-2019):
Bottom 40%: 19; Top 20%: 42%; Bottom 20%: 7%
Gini Coefficient (2010-2019): 35
Palma Index of Income Inequality (2010-2019): 1.3
Note: “Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
“Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
“Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.”
“Maternal mortality ratio – Number of deaths of women from pregnancy-related causes per 100,000 live births during the same time period (modelled estimates).”
Gini coefficient – Gini index measures the extent to which the distribution of income (or, in some cases, consumption expenditure) among individuals or households within an economy deviates from a perfectly equal distribution. A Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality.
Palma index of income inequality – Palma index is defined as the ratio of the richest 10% of the population’s share of gross national income divided by the poorest 40%’s share.
Source: United Nations Children’s Fund, The State of the World’s Children 2023: For every child, vaccination, UNICEF Innocenti – Global Office of Research and Foresight, Florence, April 2023.
“Historically, the U.K. has not systematically excluded benefits (it rather provides services to such extent as [considered] necessary to meet all reasonable requirements . This means that the relatively high growth in OOP [Out-Of-Pocket spending] (2nd after the Netherlands) in 2004–2014 must be mostly ascribed to increased cost sharing requirements. Still, per capita OOP spending has been very low by international standards, with only those in France spending less. 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 . “
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.
“The archetypal Beveridge model is the traditional system of the United Kingdom, of a single payer, financed by national taxation, with a National Health Service in which providers of publicly financed services are owned publicly, and access to hospital specialists is typically by referral via a general practitioner (GP).”
Source: Bevan G, Helderman JK, Wilsford D: Changing choices in health care: implications for equity, efficiency and cost. Health Econ Policy Law. 2010, 5 (3): 251-67. 10.1017/S1744133110000022.
“Ordinarily resident citizens in the United Kingdom enjoy access to a National Health Service (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 United Kingdom. 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. The United Kingdom Government allocates a set budget for health care in England, whereas Scotland, Wales and Northern Ireland receive a general block grant for public spending that is distributed according to funding priorities decided by each devolved government. At the local level, clinical commissioning groups (CCGs) in England (to be replaced by integrated care systems by July 2022), health boards in Scotland and Wales, and the health and social care board in Northern Ireland are responsible for commissioning or planning health and care services in their respective areas. These local organisations are expected to implement priorities outlined with national plans or strategies, such as the NHS Long-Term Plan in England, the National Performance Framework in Scotland, A Healthier Wales: long-term plan for health and social care in Wales, and Commissioning Plan Directions in Northern Ireland. There is a complex landscape of health care regulators across the United Kingdom, with some such as General Medical Council, and Nursing and Midwifery Council having a United Kingdom-wide remit, and others specific to individual countries such as the Care Quality Commission in England. For health technology assessment, the United Kingdom has developed a rigorous and transparent system through the efforts of the National Institute for Health and Care Excellence (NICE) in England, Scottish Medicines Consortium (SMC) in Scotland, and All Wales Medicines Strategy Group (AWMSG) in Wales, using the cost per quality-adjusted life-year (QALY) and the threshold approach.”
“The NHS provides cover for a wide range of benefits to individuals ordinarily resident in the United Kingdom – overseas visitors and illegal immigrants are not normally entitled to receive NHS care, with some exceptions (emergency care, care to children and treatment for infectious diseases). The publicly financed benefits package, while comprehensive, is not clearly defined and there is a degree of variation across regions. User charges are applied to ophthalmic care, most dental care and outpatient prescriptions, as well as to certain products. There is a system of exemption from prescription charges for children, people aged 65 years and older, pregnant women, people with chronic illnesses and some lower-income groups. Scotland, Wales and Northern Ireland have abolished the prescription charge for medicines, but in England it remains in place, at pound sterling (GBP)
8.20 per prescription in 2015.”
Source: Thomas Foubister and Erica Richardson. “United Kingdom.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.
“Patients in the United Kingdom cannot opt out of coverage by the NHS, irrespective of whether they may choose to access services in the independent sector through out-of-pocket payments or through supplementary private medical insurance (Table 2.5). The relevant commissioning body in England, health board in Scotland or Wales, and health and social care trust in Northern Ireland, is based upon their geographical location and can be only changed if they move. Patients can register with any GP surgery, irrespective of location, and many choose to do so; however, GP surgeries can refuse registration if they are not taking new patients or it is too far away to undertake home visits. It is also technically feasible for patients to choose any NHS hospital as long as their GP is willing to refer them. Patient choice has been promoted as a lever to facilitate competition and improve quality of care in England (Brekke et al., 2021), however, patient choice has not been promoted in Scotland, Wales or Northern Ireland (although these countries are substantially smaller than England and there are a smaller number of providers, particularly for specialist services).
“Shared decision-making is now being actively encouraged by policymakers in all four United Kingdom constituent countries, including through initiatives such as the Evidence Based Interventions Programme in England (NHS England, 2020c), Realistic Medicine in Scotland (NHS Scotland, 2018), and Prudent Healthcare in Wales (Addis et al., 2019). The General Medical Council (GMC) has long recommended this approach in its guidance for doctors, and shared decision-making gained legal support in 2015 when the United Kingdom Supreme Court decided that patients with adequate mental capacity must be properly advised about their treatment options and the risks associated with each so they can make more informed decisions (Chan et al., 2017). Patients can request a second opinion if their GP is willing to refer them to an alternative specialist; however, patients do not have a legal right to a second opinion.”
“A founding principle of the NHS is that health care is accessible to all legal United Kingdom residents, based on clinical need, regardless of their ability to pay. This major strength of the NHS means that United Kingdom residents enjoy one of the highest levels of protection against the financial consequences of ill-health in the world (see Section 7.3, Financial protection) Any resident can use NHS health care services, usually without paying at the point of access. Rules vary slightly across the United Kingdom in the definitions, but generally, “ordinarily” resident people can access health care anywhere in the United Kingdom. “Ordinarily” means that the residence is not temporary and that the individual is in the country legally. “Overseas visitors” can receive emergency medical treatment for free, but subsequent care is usually charged. Other services provided free of charge irrespective of residence status include primary care services, family planning services, treatment for some infectious diseases and compulsory psychiatric treatment (UK Government, 2021e). Despite lobbying by the Royal College of Midwives (Wise, 2019), maternity care results in charges for non-ordinarily residents, creating barriers for many vulnerable and pregnant women to access cost-effective and preventive care.”
“The NHS does not have an explicit list of benefits; instead there is legislation that outlines broad categories of health care services that should or could be provided in the NHS (Mason, 2005). As discussed, there are benefits that are explicitly excluded, including prescription charges in England, dental care and optometry (NHS England, 2021p). However, exemptions exist for young and older people, and for those on low incomes. The NHS Constitution for England in 2009 established a set of rights for people working for and using the NHS, but this constitution mostly pulled together laws and rights that were already established (see Section 2.8.3, Patient rights). Similar constitutions do not exist in Scotland, Wales or Northern Ireland. Instead, a set of published core principles and values are intended to guide governance and service delivery in these countries. Increasingly as ICSs and sustainability transformation partnerships have been developed across England, there have been calls to clarify and strengthen legislation regarding their responsibilities and patient rights.
“Through delegation, the various health boards in England, Scotland, Wales and Northern Ireland decide what treatments will be funded when commissioning (purchasing) and delivering (providing) services. At the local level, commissioning bodies or health boards also have some autonomy in making decisions about what services they will provide to their populations, given budgetary constraints. This has led to complaints of postcode lotteries, wherein some areas will cover certain services or treatments that are not available in a neighbouring region. This is the case for services such as fertility treatment (Fertility Fairness, 2021), and some elective surgical procedures (Royal College of Surgeons of England, 2014). Several initiatives have been developed, which aim to even out postcode lotteries, address unwarranted clinical variation and improve equity between regions. From the health technology assessment perspective, NICE provides NHS organisations in England, Northern Ireland and Wales with cost-effectiveness analyses that can serve as guidance on how to allocate resources most efficiently (see Section 2.7.2, Regulation and governance of provision). Scotland refers to the Scottish Intercollegiate Guidelines Network for such guidance. Initiatives to address unwarranted clinical variation and reduce provision of low-value care, include the Getting it Right the First Time (NHS England, 2021h) and the Evidence-Based Interventions programme in England (NHS England, 2020c), Realistic Medicine in Scotland (NHS Scotland, 2018) and Prudent Healthcare in Wales (NHS Wales, 2019b).”
“Out-of-pocket payments do exist and include co-payments, and costs shared with the NHS for dental care and, in England, outpatient prescription charges (Table 3.4). Direct payments can include private treatment, social care, general ophthalmic services and over-the-counter medicines. In total, out-of-pocket payments account for 16.7% of health expenditure in the United Kingdom (Table 3.3). It should be noted that the largest component is on long-term care, which is likely to reflect out-of-pocket payments to access adult social care, accounting for 5.3% of total health expenditure in the United Kingdom. For these reasons, out-of-pocket payments to access NHS services are likely to reflect a much lower percentage of total health expenditure. Broadly, the NHS provides a high level of protection from the financial consequences of ill-health, but important exceptions do contribute to inequity of access (Box 3.1).”
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Page last updated July 31, 2023 by Doug McVay, Editor.