Если у вас возникли сложности с курсовой, контрольной, дипломной, рефератом, отчетом по практике, научно-исследовательской и любой другой работой - мы готовы помочь.
Предоплата всего
Подписываем
Common features |
Differences |
Healthcare in the United Kingdom is a devolved matter, meaning England, Northern Ireland, Scotland and Wales each have their own systems of private and publicly funded healthcare. Each country having different policies and priorities has resulted in a variety of differences existing between the systems.[1][2] That said, each country provides public healthcare to all UK permanent residents that is free at the point of need, being paid for from general taxation. In addition, each also has a private healthcare sector which is considerably smaller than its public equivalent, with provision of private healthcare acquired by means of private health insurance, funded as part of an employer funded healthcare scheme or paid directly by the customer, though provision can be restricted for those with conditions such as AIDS/HIV.[3]
Taken together, the World Health Organization, in 2000, ranked the provision of healthcare in the United Kingdom as fifteenth best in Europe and eighteenth in the world.[4][5] A more recent report, the Commonwealth Fund Mirror, Mirror on the Wall survey of seven first worldhealthcare systems, ranked the United Kingdom as second overall, taking first place in subcategories including effective care and efficiency.[6] Overall, around 8.4 per cent of the United Kingdom's gross domestic product is spent on healthcare, which is 0.5% below the Organisation for Economic Co-operation and Development average and about one percent below the average of the European Union.[7]
Most healthcare in England is provided by the National Health Service (NHS), England'spublicly funded healthcare system, which accounts for most of the Department of Health's budget (£98.6 billion in 2008-9[8]). The actual delivery of health care services is managed by ten Strategic Health Authorities and, below this, locally accountable trusts and other bodies.[9] Social care services are a shared responsibility with the local NHS and the local government Directors of Social Services under the guidance of the DH. From the birth of the NHS in 1948, private healthcare has continued to exist, paid for largely by private insurance. In recent years, despite some evidence that a large proportion of the public oppose such involvement,[10] the private sector has been used to increase NHS capacity. In addition, there is some relatively minor sector crossover between public and private provision with it possible for some NHS patients to be treated in private healthcare facilities[11] and some NHS facilities let out to the private sector for privately funded treatments or for pre- and post-operative care.[12] However, since private hospitals tend to manage only routine operations and lack a level 3 critical care unit (orintensive therapy unit), unexpected emergencies may lead to the patient being transferred to an NHS hospital[13] as very few private hospitals have a level 3 critical care unit (or intensive therapy unit),[14] putting the patients at greater risk and costing the NHS money.
The two main kinds of trusts in the NHS, reflecting purchaser/provider roles, are commissioning trusts such as Primary Care Trustswhich examine local needs and negotiate with providers (that may be public or private entities) to provide health care services to the local population, and provider trusts which are NHS bodies delivering health care service. They will be involved in agreeing major capital and other health care spending projects in their region.[9] Services commissioned include general practice physician services (most of whom are private businesses working under exclusive contract to the NHS), community nursing, local clinics and mental health service. For most people, the majority of health care is delivered in a primary health care setting. Provider trusts are care deliverers, the main examples being the hospital trusts and the ambulance trusts which spend the money allocated to them by the commissioning trusts. Hospitals, as they tend to provide more complex and specialized care, receive the lion's share of NHS funding.[15] The hospital trusts own assets (such as hospitals and the equipment in them) purchased for the nation and held in trust for them.[9] Commissioning has also been extended to the very lowest level enabling ordinary doctors who identify a need in their community to commission services to meet that need. Primary care is delivered by a wide range of independent contractors such as GPs, dentists, pharmacists and optometrists and is the first point of contact for most people. Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector, though the majority of secondary care happens in NHS owned facilities.[16]There are also (as of 2009) 246 Memory clinics in the United Kingdom.[17]
The NHS Constitution covers the rights and obligations of patients and staff, many of which are legally enforceable.[18] The NHS has a high level of popular public support within the country: an independent survey conducted in 2004 found that users of the NHS often expressed very high levels satisfaction about their personal experience of the medical services they received: 92% of hospital in-patients, 87% of GP users, 87% of hospital outpatients, and 70% of Accident and Emergency department users.[19] However, only 67% of those surveyed agreed with the statement "My local NHS is providing me with a good service”, and only 51% agreed with the statement “The NHS is providing a good service.[19] Satisfaction in successive surveys has noted high satisfaction across all patient groups, especially recent inpatients, and user satisfaction is notably higher than that of the general public. The report found that most highly recalled sources of information on the NHS are perceived to be the most critical. The national press was seen to be the most critical (64%), followed by local press (54%) and TV or radio (51%) compared to just 13% saying the national press is favourable). The national press was reported as being the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable).[19] Newspapers were reported as being less favourable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable)
Common features of English system with systems of other parts of UK
Each NHS system uses General Practitioners(GPs) to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency (A&E) departments. Pharmacies (other than those within hospitals) are privately owned but have contracts with the relevant health service to supply prescription drugs.
Each public healthcare system also provides free[22] ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patients are not fit to travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St Andrews Ambulance Association and St John Ambulance). In addition, patient transport services by air are provided by the Scottish Ambulance Service in Scotland and elsewhere by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services[23]) throughout England and Wales.[24] In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion.[25]
Each NHS system also provides dental services through private dental practises and dentists can only charge NHS patients at the set rates for each country. Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS,[26] however not all dentists choose to do NHS work.
Differences
Advice services
Each NHS system has its own 24-hour telephone advisory service: England has NHS Direct,[27] Wales has NHS Direct Wales/Galw Iechyd Cymru[28] while Scotland has NHS24.[29]
Best practice and cost effectiveness
In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. These guidelines are established by panels of medical experts who specialize in the area being reviewed.
In Scotland, the Scottish Medicines Consortium advises NHS Boards there about all newly licensed medicines and formulations of existing medicines as well as the use of antimicrobiotics but does not assess vaccines, branded generics, non-prescription-only medicines (POMs), blood products and substitutes or diagnostic drugs. Some new drugs are available for prescription more quickly than in the rest of the United Kingdom. At times this has led to complaints.[30]
Cost control
The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland.[31]
Parking charges
Parking charges at hospitals have been abolished in Scotland (except for 3 PFI hospitals)[32] but continue to be in place at many hospitals in England, Parking charges have also been abolished in Wales[33]
Prescription charges
Northern Ireland, Scotland and Wales no longer have prescription charges. However, in England, a prescription charge of £7.40 is payable per item, though patients under 16 years old (19 years if still in full-time education) or over 59 years get prescribed drugs are exempt from paying as are people with certain medical conditions, those on low incomes and those prescribed drugs for contraception.
Policlinics
Main article: Policlinics in England
Policlinics are being trialled in England alone, in London and other suburban areas.
Role of private sector in public healthcare
Whereas the United Kingdom Government is expanding the role of the private sector within the NHS in England,[34][35] the current Scottish government is actively reducing the role of the private sector within public healthcare in Scotland[36] and planning legislation to prevent the possibility of private companies running GP practices in future.[37]
Funding and performance of healthcare since devolution
In January 2010 the Nuffield Trust published a comparative study of NHS performance in England and the devolved administrations sincedevolution, concluding that while Scotland, Wales and Northern Ireland have had higher levels of funding per capita than England, with the latter having fewer doctors, nurses and managers per head of population, the English NHS is making better use of the resources by delivering relatively higher levels of activity, crude productivity of its staff, and lower waiting times.[38] However, the Nuffield Trust quickly issued a clarifying statement in which they admitted that the figures they used to make comparisons between Scotland and the rest of the United Kingdom were inaccurate due to the figure for medical staff in Scotland being overestimated by 27 per cent.[39] Using revised figures for medical staffing, Scotland's ranking relative to the other devolved nations on crude productivity for medical staff changes, but there is no change relative to England.[40] The Nuffield Trust study was comprehensively criticised by the BMA which concluded "whilst the paper raises issues which are genuinely worth debating in the context of devolution, these issues do not tell the full story, nor are they unambiguously to the disadvantage of the devolved countries. The emphasis on policies which have been prioritised in England such as maximum waiting times will tend to reflect badly on countries which have prioritised spending increases in other areas including non-health ones.[41]
Task 2
The Cost of Free Government Health Care
(by David Gibberman, AmericanThinker.com) - Proponents of government-run health care like to point out that countries with such a system spend a smaller percentage of their gross domestic product on health care than the United States. What they don’t like to mention is how those savings are achieved. For example:
Patients Lose the Right To Decide What Treatment They’ll Receive. Instead, patients receive whatever care politicians and bureaucratic number crunchers decide is “cost effective.”
Britain’s National Institute for Health and Clinical Excellence usually won’t approve a medical procedure or medicine unless its cost, divided by the number of quality-adjusted life years that it will give a patient, is no more than what it values a year of life in great health – £30,000 (about $44,820). So if you want a medical procedure that is expected to extend your life by four years but it costs $40,000 and bureaucrats decide that it will improve the quality of your life by 0.2 (death is zero, 1.0 is best possible health, and negative values can be assigned), you’re out of luck because $40,000 divided by 0.8 (4 X 0.2) is $50,000.
There Are Long Waits for Care. One way governments reduce health care costs is to require patients to wait for treatment. Patients have to wait to see a general practitioner, then wait to see a specialist, then wait for any diagnostic tests, and then wait for treatment.
The United Kingdom’s National Health Service recently congratulated itself for reducing to 18 weeks the average time that a patient has to wait from referral to a specialist to treatment. Last year, Canadians had to wait an average of 17.3 weeks from referral to a specialist to treatment (Fraser Institute’s Waiting Your Turn). The median wait was 4.9 weeks for a CT scan, 9.7 weeks for an MRI, and 4.4 weeks for an ultrasound.
Delay in treatment is not merely an inconvenience. Think of the pain and suffering it costs patients. Or lost work time, decreased productivity, and sick pay. Worse, think of the number of deaths caused by delays in treatment.
Patients Are Denied the Latest Medical Technology and Medicines. To save money, countries with government-run health care deny or limit access to new technology and medicines. Those with a rare disease are often out of luck because medicines for their disease usually cost more than their quality-adjusted life years are deemed worth.
In a Commonwealth Fund/Harvard/Harris 2000 survey of physicians in the United States, Canada, New Zealand, Australia, and the United Kingdom, physicians in all countries except the United States reported major shortages of resources important in providing quality care; only U.S. physicians did not see shortages as a significant problem. According to the OECD (Organisation for Economic Co-operation and Development) Health Data (2008), there are 26.5 MRIs and 33.9 CT scanners per million people in the United States compared to 6.2 MRIs and 12 CT scanners in Canada and 5.6 MRIs and 7.6 CT scanners in the United Kingdom.
Breakthroughs in Life-Saving Treatments Are Discouraged. Countries with government-run health care save money by relying on the United States to pay the research and development costs for new medical technology and medications. If we adopt the cost-control policies that have limited innovation in other countries, everyone will suffer.
The Best and Brightest Are Discouraged from Becoming Doctors. Countries with government-run health care save money by paying doctors less. According to a Commonwealth Fund analysis, U.S. doctors earn more than twice as much as doctors in Canada and Germany, more than three times as much as doctors in France, and four times as much as doctors in Finland, Norway, and Sweden. The best and brightest will be encouraged to go into professions where they can earn more money and have more autonomy.
Is Government-Run Health Care Better? Proponents of government-run health care argue that Americans will receive better care despite the foregoing. Their main argument has been that despite paying more for health care the United States trails other countries in infant mortality and average life expectancy.
However, neither is a good measure of the quality of a country’s health care system. Each depends more on genetic makeup, personal lifestyle (including diet and physical activity), education, and environment than available health care. For example, in their book The Business of Health, Robert L. Ohsfeldt and John E. Schneider found that if it weren’t for our high rate of deaths from homicides and car accidents Americans would have the highest life expectancy.
Infant mortality statistics are difficult to compare because other countries don’t count as live births infants below a certain weight or gestational age. June E. O’Neill and Dave M. O’Neill found that Canada’s infant mortality would be higher than ours if Canadians had as many low-weight births (the U.S. has almost three times as many teen mothers, who tend to give birth to lower-weight infants).
A better measure of a country’s health care is how well it actually treats patients. The CONCORD study published in 2008 found that the five-year survival rate for cancer (adjusted for other causes of death) is much higher in the United States than in Europe (e.g., 91.9% vs. 57.1% for prostate cancer, 83.9% vs. 73% for breast cancer, 60.1% vs. 46.8% for men with colon cancer, and 60.1 vs. 48.4% for women with colon cancer). The United Kingdom, which has had government-run health care since 1948, has survival rates lower than those for Europe as a whole.
Proponents of government-run health care argue that more preventive care will be provided. However, a 2007 Commonwealth Fund report comparing the U.S., Australia, Canada, Germany, New Zealand, and the United Kingdom found that the U.S. was #1 in preventive care. Eighty-five percent of U.S. women age 25-64 reported that they had a Pap test in the past two years (compared to 58% in the United Kingdom); 84% of U.S. women age 50-64 reported that they had a mammogram in the past two years (compared to 63% in the United Kingdom).
The United Kingdom’s National Health Service has been around for more than 60 years but still hasn’t worked out its kinks. In March, Britain’s Healthcare Commission (since renamed the Care Quality Commission) reported that as many as 1,200 patients may have died needlessly at Stafford Hospital and Cannock Chase Hospital over a three-year period. The Commission described filthy conditions, unhygienic practices, doctors and nurses too few in number and poorly trained, nurses not knowing how to use the insufficient number of working cardiac monitors, and patients left without food, drink, or medication for as many as four days.
Does Government-Run Health Care Provide Everyone Access to Equal Care? Proponents tout government-run health care as giving everyone access to the same health care, regardless of race, nationality, or wealth. But that’s not true. The British press refers to the National Health Service as a “postcode lotter” because a person’s care varies depending on the neighborhood (“postcode”) in which he or she lives. EUROCARE-4 found large difference in cancer survival rates between the rich and poor in Europe. The Fraser Institute’s Waiting Your Turn concludes that famous and politically connected Canadians are moved to the front of queues, suburban and rural residents have less access to care than their urban counterparts, and lower income Canadians have less access to care than their higher income neighbors.
Ironically, as we’re moving toward having our government completely control health care, countries with government-run health care are moving in the opposite direction. Almost every European country has introduced market reforms to reduce health costs and increase the availability and quality of care. The United Kingdom has proposed a pilot program giving patients money to purchase health care. Why is this being done? According to Alan Johnson, Secretary for Health, personal health budgets “will give more power to patients and drive up the quality of care” (The Guardian, 1/17/09). It’s a lesson we all should learn before considering how to improve our health care system.