The UK performs better (third place) than, for example, Germany (second last place). The UK's healthcare system is often heavily criticized as being on the brink of collapse - any explanation for this?
The actual report [1] says it took five domains into account: a) access to care,
b) care process, c) administrative efficiency, d) equity, and e) health outcomes. Read the linked summary.
To summarize the summary: from 10 investigated countries, 9 are in the same ballpark. The US is an extreme outlier, bad in almost anything and expensive to boot.
The NHS being in trouble is apparently orthogonal to these domains. It is just unable to cover its cost with the income it has. But NHS is a gem, don't let anybody tell you otherwise. It does a marvelous job with the money it has. The reports laud it for its smart and efficient administrative process, affordability (for the citizen) and to a lesser degree for availability and access. While by no means bad it can improve on the actual care process and the results (which costs money). The NHS seems to be doing a good job and works as intended. The administration, for once, is apparently not to blame. So, what are the things that make people say the NHS is on the brink of collapse in the first place?
The NHS manages demand by rationing with queues rather than prices. That seems not to be accounted for. You get great care once they get round to you, but people routinely wait months or years in pain for fairly routine treatments.
I don't really know what the answer is because eroding "free at the point of use" will also push a load of people out of healthcare.
> The NHS manages demand by rationing with queues rather than prices. That seems not to be accounted for. You get great care once they get round to you, but people routinely wait months or years in pain for fairly routine treatments.
For what it's worth (don't let the politicians tell you otherwise) the US is the exact same way.
Here, because it's all about profit and margins are so thin, there's no slack in the system. It takes literally months to book an appointment with my primary care doctor. If you aren't already "established" it might take even longer.
Tests for not-immediately-life-threatening things are the same way. You get the next available slot which could be weeks or months out.
There aren't free slots floating around because they want all the staff busy all the time.
And you might think "well can't you pay extra to get to the front of the line?" The answer is well... I can't. Maybe there's some income level that this is possible or secret handshake, but it's not accessible to middle class people.
The issue with the debate over "free at the point of use" is that it is often framed as two extremes: It's either free or we'll have the same as the US where people are pushed out of healthcare on price (ignoring the counter-examples of most other developed countries).
But in reality there is a vast continuum between "free" and prohibitively expensive. There is also of course the option that some categories get "free" care in any case (like prescriptions now, which in England are £9.90 in general but 0 for children and people on specific benefits).
"Free at the point of use" is totemic of the NHS and any suggestions of change are rejected as a matter of quasi-religion (which can be seen in a few comments here to some extent)
Are you living in the UK or just making baseless assumptions? For an ever-inceasing number of serious health issues, the NHS has been essentially non-functional for many years. I have friends with chronic conditions that are looking to emigrate becase they're dreading their health getting worse in a system that's doing nothing to help them.
"NHS would be great except for the bad politicians" is not a serious argument.
It's underfunded. I'm willing to bet that the countries they're thinking of moving to either spend more on healthcare as a proportion of GDP than the UK does or don't have healthcare that's free at the point of use (or both).
The UK's healthcare system isn't failing, it's being failed. There's been a constant cycle of defunding the NHS because it is bad and the NHS becoming worse from a lack of funding. The obvious end goal is full privatization once the system becomes defunct enough for that to be sold as a "tough but necessary" decision. There is also very blatant lobbying from US healthcare firms in the UK as they would seek to expand into the UK once they no longer have to compete with the NHS.
It's effectively self-imposed austerity, which has been demonstrated to produce worse outcomes than investing in public services instead. There's an obvious conflict of interest at play as politicians (in the UK especially thanks to its governmental system) rarely have to rely on these public services as they can easily afford private alternatives.
There's also the factor of Western corruption. In Germany for example the health minister during the early pandemic owned a significant stake in several pharmacies while at the same time pushing for and implementing a mask subsidy that created massive profits for pharmacies handing out masks at or below cost. These ties are often legal despite the obvious conflict of interest.
Those rankings are of course heavily influenced by the methodology and metrics chosen. Differences can be very small but obviously even a very small relative difference results in a higher or lower ranking. That's how rankings work.
For instance, in this case: "The U.K.’s health system is the top one for affordability... In the U.K., the National Health Service (NHS) provides free public health care, including hospital, physician, and mental health care"
This does not mean it is 'better' or that others are in fact unaffordable.
For instance, in France a visit to the GP costs 30 Euros but 28 are covered by social security and private cover. Arguably 2 euros make no difference vs. "free" but it's just that you can beat "free" when ranking on affordability.
That being said, I think anyone with experience with the UK and other European countries' healthcare systems will be surprised, shall we say, with this ranking overall...
Throw in noisy unions, elections (despite the idea of a Conservative government actually privatising the NHS being absurd), and pay comparisons to other countries that don't account for inflation, locuming, and private work - and here we are.
Not to say it's the best and couldn't be better or anything, but I do think the discourse and perception is way out of proportion.
The only explanation is that the "report" is obviously detached from reality and using massaged metrics to make political points. The NHS is as bad as it gets.
"More than 120,000 people in England died last year while on the NHS waiting list for hospital treatment, figures obtained by Labour appear to show. That would be a record high number of such deaths, and is double the 60,000 patients who died in 2017/18."
Everything is relative. Most people only use health care in their own countries and therefore can only compare to another time in their own country. So if it used to be better in the UK, it might feel really bad now. If it's always been meh in Germany, it probably feels ok there, since it's always been that way.
Also, populism. Healthcare is a major point in the UK elections. It's been a major talking point for the left that healthcare is awful now due to bad policy by the right. Something doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down.
> It's been a major talking point [...] doesn't have to be objectively true for people to feel like it is true. Just like everyone always thinks crime is up even when it's down.
I'm sorry, but no. It's not just a talking point. As someone with family in both countries, as well as having parents that have worked in both medical systems: The NHS waiting lists are genuinely bad and this isn't all in peoples' heads.
It's not even a "left vs right" issue; no one thinks the system is working right now.
> It's not even a "left vs right" issue; no one thinks the system is working right now.
That's true but as always the difference between left vs right (populism) is not what is being said but what the proposed solution is. This goes for many things: healthcare, immigration, poverty, etc. The issues are hot button topics but the proposed or implied solutions vary drastically. Alas of course the left in countries like the UK and Germany have become very centrist and instead of proposing different solutions from the right often join the moderate conservatives in suggesting what the right says "but less". This results in aimless reformism, means testing and bureaucracy which further feeds into far right populism by demonstrating "the left" as incompetent.
The system is chronically underfunded (despite the massive amounts of tax revenue it already receives.) Doctors can make much more going private and the public doesn't really feel like paying more in taxes for doctors in the NHS. Plus the inherent waste that comes with every government bureaucracy with access to what feels like ~unlimited funds, with no incentive or competition to be efficient on costs. Vicious cycle.
To summarize the summary: from 10 investigated countries, 9 are in the same ballpark. The US is an extreme outlier, bad in almost anything and expensive to boot.
The NHS being in trouble is apparently orthogonal to these domains. It is just unable to cover its cost with the income it has. But NHS is a gem, don't let anybody tell you otherwise. It does a marvelous job with the money it has. The reports laud it for its smart and efficient administrative process, affordability (for the citizen) and to a lesser degree for availability and access. While by no means bad it can improve on the actual care process and the results (which costs money). The NHS seems to be doing a good job and works as intended. The administration, for once, is apparently not to blame. So, what are the things that make people say the NHS is on the brink of collapse in the first place?
[1] https://www.commonwealthfund.org/publications/fund-reports/2...