---

Total Health Spending, USD PPP Per Capita (2020): $5,387

(Note: “Health spending measures the final consumption of health care goods and services (i.e. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Health care is financed through a mix of financing arrangements including government spending and compulsory health insurance (“Government/compulsory”) as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations (“Voluntary”). This indicator is presented as a total and by type of financing (“Government/compulsory”, “Voluntary”, “Out-of-pocket”) and is measured as a share of GDP, as a share of total health spending and in USD per capita (using economy-wide PPPs).”

Source: OECD (2023), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 22 June 2023).

---

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.

---

Annual household out-of-pocket payment in current USD per capita, 2021: $693

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed May 13, 2023.

---

Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2019): 19.7%
Population with household expenditures on health greater than 10% of total household expenditure or income (2012-2020) (%): 2.3%
Population with household expenditures on health greater than 25% of total household expenditure or income (2012-2020) (%): 0.4%

---

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.

---

“In line with the EU average, health services are predominantly financed from general taxation and in 2017, 78.8 % of total health expenditure came from public sources. Voluntary Health Insurance plays a marginal, supplementary role in the system (3.1 % of total health expenditure) and out-of-pocket (OOP) spending is low (16 %) compared to most other EU countries. Financial protection is stronger in the United Kingdom than in many other EU countries, as most NHS services are free at the point of use for legal residents (Section 5.2). Fixed charges are applied to dental care and prescription pharmaceuticals (in England only), although several groups (such as children, pregnant women, people on low incomes and others) are exempted (see Section 5.2).

“Most spending on health services goes towards outpatient (or ambulatory) care (31 %) but this is closely followed by inpatient services (29 %), both of which are comparable to EU averages. Per person, pharmaceutical expenditure lies below the EU-wide average (Figure 8) as a greater share of pharmaceutical spending is on generics (Section 5.3), while considerably more is spent on preventive services than in other countries (EUR 165 or over 5 % of health spending in 2017, compared with 3 % across EU countries).”

---

“In 2017, health expenditure in the United Kingdom was slightly higher than the EU average per person – EUR 2,900 (adjusted for differences in purchasing power) compared to EUR 2,884, and slightly lower as a proportion of GDP (9.6 % compared with 9.8 % for the EU). However, as shown in Figure 7, health expenditure is considerably lower than similarly wealthy countries such as Germany (EUR 4,300 per capita, 11.2 % GDP) and France (EUR 3 626, 11.3 %). This level of spending has been relatively stable over time, but it has not kept pace with growing demand for health services (European Commission, 2019a) (see Section 5.2).”

---

“In 2014, public spending accounted for 83.1% of total spending on health, with OOP [Out Of Pocket] payments and VHI [Voluntary Health Insurance] accounting for 9.7 and 3.4%, respectively (WHO, 2016). Public spending on health has dominated since the founding of the NHS in 1948 (Boyle, 2011).”

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.

---

“Over the last few decades, health spending in the United Kingdom has gone through cycles of sustained growth and austerity, often termed by the media as periods of “feast and famine”. The most recent and particularly prolonged period of austerity was between 2010 and 2017, heralded by the advent of the 2008 financial crisis (see Section 1.2, Economic context, and Table 1.2). This lack of stability in funding has hampered investment in long-term priorities such as capital, leaving the United Kingdom under-resourced in terms of hospital beds, workforce and diagnostics (Anderson M et al., 2021b).

“From 2000 to 2009, there was a significant increase in health expenditure because of a political commitment to raising health care spending as a percentage of GDP to a level that corresponded more closely with the EU average. In real terms, total health spending in the United Kingdom grew 5.3% per year on average between 1997 and 2009 (ONS, 2020b). The policy of austerity from 2010 following the economic crisis of 2008 resulted in less significant increases in health spending, although health spending was relatively protected when compared with spending for other public services such as social care and local authorities, which experienced real-term decreases in spending. In real terms, total health spending grew 1.9% per year on average between 2009 and 2018. With around half of NHS expenditure spent on staff, the budget constraints have had an impact on the NHS workforce. NHS England salaries had an annual 1% cap on pay rises between 2013 and 2017, which was preceded by a freeze on public sector pay between 2011 and 2013 (Powell & Booth, 2021). In June 2018, the government acknowledged that such modest increases in health care spending were not sustainable in the long term and announced a £20.5 billion increase in NHS England’s budget in June 2018 to be phased in over the 5-year period to 2023/2024. This represents an average per annum increase of around 3.4% in expenditure in real-terms (UK Government, 2018b), which is still below the historical average increase in health spending, at around 3.7% per year in real-terms (Charlesworth & Johnson, 2018).

“Over the last decade we have seen total health expenditure increase both in terms of spending per capita, as percentage of GDP, and as percentage of general government expenditure (Table 3.1). Now approximately £1 in every £5 of government spending is on health. The majority of funding for health in the United Kingdom comes from public sources of revenue collected through general taxation: the three largest taxes being income tax, national insurance contributions and value-added taxation. The proportion of public funding for health has remained relatively unchanged over the last two decades at around 80% (Table 3.1). Private sources of revenue account for around 20% of health spending, through private medical insurance and out-of-pocket payments. Capital health expenditure peaked at 4.5% of total health spending in 2005 and has been decreasing since.”

---

“Historically, the U.K. has not systematically excluded benefits (it rather provides services “to such extent as [considered] necessary to meet all reasonable requirements” [14]. 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 [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.

---

World 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 June 22, 2023 by Doug McVay, Editor.