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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.

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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.

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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.

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“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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“NHS dental care carries a charge throughout the United Kingdom, although exemptions exist for certain populations. In England, a three-tiered charging bands system exists to cap charges for NHS dental care dependent on the complexity of the treatment received (Table 3.4). As of 2020/2021, Band 1 treatments cost £23.80, and include examination, diagnosis and advice. Band 2 treatments cost £65.20, and cover additional treatments such as fillings, root canal treatment and tooth extractions. Band 3 treatments cost £282.80, and including complex procedures such as crowns, dentures and bridges (NHS England, 2021i). Wales also uses a three tiered charging bands system, although with slightly lower charges than in England (Welsh Government, 2021c). As of 2020/2021, there is no tier system in Scotland and Northern Ireland, and instead patients pay up to 80% of the cost of their specific treatments up to a maximum of £384 per course of treatment.”

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“NHS prescription charges in England are set at a flat rate of £9.15 per item as of 2020/2021. Patients can also pay for a yearly subscription service capped at £105.90 per year (Table 3.3). Exemptions cover a broad range of people, including individuals under 16 and over 60 years of age, those with low incomes, during pregnancy, and for chronic diseases such as diabetes or epilepsy, so that about 90% of all prescriptions are distributed free of charge (NHS England, 2021q). Prescription charges were abolished in Wales in 2007, in Scotland in 2011 and in Northern Ireland in 2010 (Kulakiewicz, Parkin & Powell, 2022). To date, there is no evidence that this has affected the growth rate of prescription items dispensed before and after the abolishment of charges (National Statistics, 2018; Williams, Henley & Frank, 2018). During the 2019 general election, the Labour Party proposed abolishing the prescription charge, estimating that approximately £575 million income would be forgone if the policy was implemented (Nicholas, 2019).”

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“Basic ophthalmic services are generally not covered under the NHS. Free eye tests are available to all in Scotland, and to eligible groups such as children and people over 60 years in England, Northern Ireland and Wales. Eligible patients can also get vouchers to help with the costs of corrective contact lenses or glasses. Over-the-counter medicines, by definition, are purchased directly and are not covered by the NHS. Travel costs incurred to get to NHS appointments may be reimbursed, so long as the patient has a referral and meets other conditions related to low income.

“As discussed in Section 1.3, Political context, and Section 2.1, Historical background, the devolved administrations of the United Kingdom are responsible for social care within their jurisdictions. This has led to variations in eligibility criteria, and differences in direct payments for social care. For example, in Scotland, personal and nursing care are free, whereas in England all social care is means-tested (Table 3.5). This often leads to substantial costs incurred by older people needing social care support. The Dilnot Commission (2011) on Fairer Care Funding in England found that one in 10 people, at age 65 years, would face future lifetime social care costs of £100,000 (Dilnot, 2011). To provide improved financial protection, the Commission recommended implementing a lifetime cap of individual contributions of £35,000, and a means-tested threshold of £100,000 (Dilnot, 2011). In late 2021, the United Kingdom Government finally announced that it would introduce a cap on the maximum amount that individuals would have to pay for social care services in England over their lifetime in 2023, initially set at £86,000 (€101,824) (see Section 6.2, Future developments).”

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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.

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Page last updated July 16, 2023 by Doug McVay, Editor.