Two-tier Health Care - United Kingdom

United Kingdom

The National Health Service (or NHS) provides universal coverage to all citizens and full-time international students in the United Kingdom.

Private health care has continued parallel to the NHS, paid for largely by private insurance: it is used by about 8% of the population, generally as an add-on to NHS services and mostly obtained through employer funded insurance schemes. This is a taxable benefit to the employee (i.e. the value is imputed by the tax authorities as income to the beneficiary). Because NHS services are so comprehensive, there are many areas where the private sector usually does not compete and private insurers almost always refuse to fund. Childbirth and perinatal services are good examples. Conversely, there are some areas where the NHS does not offer free treatment (cosmetic surgery for vanity purposes for example) and thus the private sector offers a pay-for-service alternative.

Historically, avoiding waiting lists was the main reason that patients opted out of NHS treatment and into private care. Queues of many months were, at one time, common. Consultants (senior physicians such as surgeons), who had been allowed to run both NHS and private services during their NHS contracts, used to be in charge of waiting lists and had a financial incentive to keep the public waiting list long to ensure a stream of private income to the private business.

Nowadays, strict rules apply to waiting lists. That, and the allocation of better funding in hospitals, has reduced waiting times significantly. Most hospital patients are in fact not admitted from a wait list at all and those that do on average wait less than 9 weeks. Nobody should wait more than 18 weeks. This 18 weeks is not dead time because it includes the time taken to book a first appointment, to conduct all the tests, for the doctor and patient to agree on the desired treatment, and to book and execute an operation or commence the treatment regime. A patient not seen in the 18 week period without just cause has the legal right to go private at the NHS's expense.

As a result of these improvements, long waiting times are now mostly a thing of the past and the private health care sector now sells its surplus capacity to the NHS. Dentistry is an area where many practitioners prefer to work privately (because they can set their own fees). NHS dental coverage can then be patchy and some people may find that private dentistry is the only practical option open to them in their locality.

There has always been a degree of private medicine conducted within NHS hospitals, with private work being done in those hospitals and the patient being accommodated in segregated accommodation. Until recently few NHS patients were ever treated in private sector hospitals. In the English NHS, however, there has been greater willingness to outsource some work to the private sector and therefore these days NHS patients do sometimes gain access to private health care facilities at public expense. The equivalent NHS operations in Wales, Scotland and Northern Ireland do not generally fund treatment outside of their own facilities.

Patients in the UK have complete freedom of choice as to which hospital to use, which may be NHS or private. Whether the NHS funds treatment in a private hospital is a decision for the local commissioning health authority based on formal service contracts.