[Propelloni]

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?

[1] https://www.commonwealthfund.org/publications/fund-reports/2...

[pjc50]

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.

[JeremyNT]

> 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.

[mytailorisrich]

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)

[InsideOutSanta]

"It is just unable to cover its cost with the income it has"

Which is a problem that politicians intentionally create in order to show how bad the NHS is.

[armitron]

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.

[1] https://www.independent.co.uk/news/uk/nhs-collapse-hospitals...

[2] https://edition.cnn.com/2023/01/23/uk/uk-nhs-crisis-falling-...

[3] https://www.instituteforgovernment.org.uk/comment/how-bad-nh...

[foldr]

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).