The United Kingdom is an island nation covering an area of 244,820 square kilometers (94,527 square miles) and consisting of Great Britain (the countries of England, Scotland, and Wales) and Northern Ireland. More than 80% of its 60 million inhabitants live in England. With 243 inhabitants per square kilometer (per 0.38 square mile), the UK is one of the most densely populated member countries in the European Union.
Q: What kind of healthcare system does the UK have?
A: The National Health Service (NHS) was founded in 1948 and provides those "normally resident" in the country (including overseas students, refugees, and asylum seekers but not tourists) with free, comprehensive, high-quality healthcare. At the time, it was widely considered exemplary and has become an institution, which, despite its shortcomings, still evokes feelings of national pride. The NHS employs a million people and is the largest organization of its kind in Europe.
The 99% of the British population that is registered with the NHS is entitled to free doctor visits and hospital treatment. Certain priority groups (low-income earners, pensioners, and children under 16) also receive free dental care and eye tests. A well-developed social care program is an integral part of health provision.
The general practitioner (GP) is the first contact for those seeking primary care. Individuals are required to register with a GP in their catchment area. Patients cannot consult specialists (who are hospital-based) directly they must obtain a referral from their GP. The GPs work as independent, self-employed, fee-for-service contractors. They sign a contract with the NHS to provide general medical services and are paid by the NHS. The Ministry of Health determines fees after negotiations with the profession's representatives. The average annual income of a GP is currently around £61,218 (US$102,429).
Hospital doctors (which include specialists and GPs) are employed directly by the NHS and receive a salary. Full-time consultants (senior specialists), all of whom work in hospitals, are allowed to earn up to 10% of their gross income from treating private patients. Junior hospital doctors can expect a basic starting salary of £20,917 (US$35,000) per year, rising to £35,859 (US$60,000) for more senior positions, with consultants earning even more. There are 230 private hospitals and the rest are public, as are the main teaching hospitals.
According to 2001 World Health Organization (WHO) statistics, the UK has an average of 163.93 physicians per 100,000 inhabitants compared to 279.0 in the USA and 229.1 in Canada.
Midwives are other key providers of healthcare. England alone has about 5,000 midwives, who are registered general nurses with further qualifications in women's health, pregnancy, and childbirth. They work in the community, providing services to pregnant women, performing deliveries, and providing mother/baby care for 28 days following delivery.
Q: How is the healthcare system funded?
A: The NHS is entirely government-funded. The annual cost of approximately US$70 billion (estimated to rise to nearly US$100 billion by 2005) is almost completely met through income tax payments. The remainder comes from user charges, mainly for prescriptions (priority groups are exempt from charges, all others pay about 60% of prescription costs) and dental services or surcharges for superior accommodation in hospitals.
Although the UK has increased its expenditure on healthcare (up to 7.3% of the GDP in 2001 from a mere 6% in 1999), it still lags behind most other countries in Europe and falls behind both the USA (13.7%) and Canada (9.5%). But according to the WHO year 2000 report on global healthcare, the UK ranked 18 out of 191 countries on cost-effectiveness (USA ranked 37, Canada 30).
Q: Who uses private, who public?
A: Some patients choose to pay directly for private care or to buy insurance coverage from one of the 25 independent insurance providers. There are two main reasons for resorting to direct pay or insurance. First, waiting times ranging from one to two years or more for non-emergency operations in NHS hospitals have made patients go private to "jump the queue" if only for the one occasion. For the second quarter of 2002, for instance, a total of 74,814 patients in England were waiting for hospital admission for eye, nose, and throat complaints. Of these, 44.5% waited for less than three months, 27.3% waited three to five months, 17.75 waited six to eight months, and the remainder waited longer. Second, some patients are attracted by the better standards of accommodation in private facilities. Private pay and independent insurance are used almost exclusively to cover the costs of acute healthcare in a hospital.
On the whole, the British do not consider private care to be medically superior to the NHS because the same senior specialists normally operate in both worlds.
Q: What are the current concerns among healthcare workers in the country?
A: Years of government underfunding has resulted in staff shortages and overworked and often low paid health workers trying to do a good job in challenging circumstances. Many qualified nurses cannot find any other employment except through agencies who supply NHS hospitals with temporary staff. Not surprisingly, many health professionals feel frustrated and dissatisfied with their working conditions.
Q: What are the current concerns among patients?
A: The main concern is waiting times to get appointments with specialists and to have non-emergency operations.
Years of government underfunding has meant staff shortages, and the public is concerned at being treated by overworked and underpaid health workers. Many nurses are on short-term contracts to NHS hospitals, so patients are worried about falling standards. Patients also worry about communication problems with staff members who are recruited from countries where English is not the first language.
The underfunding has also resulted in the closure of many rural hospitals, regional restrictions on certain types of treatment for certain individuals (in one case, the NHS refused to pay for chemotherapy for a child with terminal cancer), and a notorious lack of hospital beds (only 4.5 per 1,000 population). Hospital buildings often suffer from poor maintenance, lack of repair work, and cleanliness problems.
Another concern is that the government plans to set up a two-tiered system of hospitals with higher and lower levels of funding, which would require that patients travel to larger centers for specialized treatment. Foundation hospitals would be tertiary-care centers, offering advanced diagnostic and treatment. Trust hospitals, or rural facilities, would offer basic services.
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