Every once in a while, there appears an article in the US media, discussing whether Americans should adopt the British healthcare system and, vice versa, the British occasionally wonder whether they should learn from Americans in terms of healthcare provision. With this in mind, it appears important to compare the two systems and see whether there is any point for either the UK or the USA to adopt one another’s experience.
Before discussing the core differences between the US and UK healthcare systems, it is necessary to say a few words about their historic background. Thus, the UK healthcare system takes its roots in the late 1940s: established soon after the end of World War II, the system would place a special focus on the principles of humanism and equality. The symbolic birth of the UK healthcare system is when the National Health Service was founded “under the principles of universality, free at the point of delivery, equity, and paid for by central funding” (Grosios et al. 529). The US healthcare system, in turn, began to be shaped towards its current form in the time of the Great Depression, when the need for social security became especially well-articulated in society and resulted in the Social Security Act of 1935 with which the government’s coverage of healthcare insurance was introduced (Griffin par. 24). World War II, in turn, would stimulate the appearance of the employee-covered insurance: prohibited from raising salaries above the set norm, businesses looked for alternative strategies of employee retention (Griffin par. 30). In this manner, from the historic perspective, the UK and US healthcare systems are radically different in terms of the core principles and values underpinning them.
One radical difference between US healthcare and UK healthcare is that the former system is predominantly private, whereas the latter system is predominantly public. Thus, most hospitals in the USA are owned by private companies. One central advantage of this is that the US system is very responsive: the USA entered the twenty-first century as the top-ranked world’s healthcare system in terms of responsiveness (WHO par. 23). The correlation between private ownership and the responsiveness of a healthcare system is empirically proved: in their research on factors underpinning the responsiveness of a healthcare system, Robone et al. point out that one strategy, which should be considered to increase the responsiveness of a healthcare system, is “the expansion of nonpublic sector provision, perhaps in the form of increased patient choice” (2019).
This might be explained by the fact that private-based hospitals are, above all else, concerned about their revenues. In this regard, they operate just like any other business, that is, they strive to, first and foremost, ensure that clients’ needs are satisfied. In contrast to this, the majority of hospitals in the UK are public hospitals, and the need for the system’s improvement in terms of responsiveness is widely acknowledged (Cylus 39). This is explained not only by the fact that most of the UK’s hospitals are public but also by the fact that the UK system is far more constrained in terms of finances: while the USA spends more money on healthcare than any other nation in the world, the spending of the UK is more modest as compared to other developed countries (Grosios et al. 530; “How Does The U.S. Healthcare System Compare To Other Countries?” par. 3). Just like the correlation between responsiveness and public ownership is verified by empiric research, that between responsiveness and healthcare expenditures likewise has some empirical underpinning (Robone 2097). To summarize, one core difference between the US and UK healthcare systems is that the former is more responsive than the latter. This core difference, in turn, is primarily explained by the fact that most US hospitals are privately owned and that the USA spends far more money on healthcare than the UK does.
The second core difference between the US and UK healthcare systems relates to the quality of care, which the two systems offer. In this regard, it should be clarified that the concept of quality is a broad and complex one. Overall, the quality of healthcare is measured by assessing population health, which is, in turn, measured by assessing such variables as infant mortality and population life expectancy. From this perspective, the two healthcare systems are relatively equal demonstrating generally good outcomes, which are, in the meantime, far behind the outcomes achieved by top-performing countries such as Japan or Sweden (Ham 597). Apart from these traditional indicators of the quality of a healthcare system, there is also such indicator as equity, that is, the extent to which different groups are equally served by the healthcare system. From this standpoint, the UK healthcare system shows farm more favorable results: although it is not sufficiently responsive, most of the British view it as equitable as opposed to the US healthcare system, to which the problem of inequality is of central importance (Ham 597). This difference is primarily rooted in the different approaches to financing, which the two states use.
Thus, the UK uses the classic tax-based approach to healthcare financing. This means that all the British can access healthcare services and the costs will be covered by the government that, in turn, takes the necessary money from the collected tax. In this case, the system serves the population more or less proportionally even though it might be not sufficiently responsive to satisfying all their concerns and needs. In contrast to this, the USA uses a mixed financing system. Under this system, the government covers the insurance costs for certain groups (e.g., the elderly, military veterans, etc.), whereas other groups either receive their insurance coverage from their employers or cover the insurance themselves if they can. This results in a situation, where many groups do not have any insurance coverage at all. As Ham writes, “around 45 million Americans under the age of 65 lack health insurance cover, and far more US citizens than UK citizens report that the cost of health care is a barrier to access” (597). When discussing this difference in the effectiveness of the two systems, it is also important to keep in mind the aforementioned fact that the USA spends far more money on healthcare than the UK does and so the gap in effectiveness looks even more concerning when approached through the lens of ROI.
The comparison between the US and UK systems shows that each of the two systems has its own strengths and weaknesses. All their differences are deeply rooted in their historic background. Thus, the UK system was established with the prior focus on such values as humanism and equality and this determined its state-based financing structure. In the long run, this has resulted in a situation, where the system demonstrates good equity and the population is generally satisfied with its quality despite limited finances and poor responsiveness. In contrast to this, the US system underwent multiple transformations and modifications in the process of its development which has determined its complicated system of insurance coverage. In a long-term perspective, this has resulted in a situation, where the system demonstrates poor equity and the population is not satisfied with its quality despite the good responsiveness of the system and the largest funding in the world. Therefore, even if the US would decide to adopt some lessons from the UK system, this would be a challenging task because their primary task would be to utterly restructure the way healthcare costs are covered.