The NHS at 70: a comparison of British and American healthcare.

by Emily Stone

            In this week's edition of the British Medical Journal, the magazine celebrates 70 years of the NHS, with an article entitled ‘Vote for the greatest achievement of the NHS at 70’. The full list can be found here: https://www.bmj.com/content/361/bmj.k2121 . However,  in light of this, I would like to highlight the three achievements I consider to be the most important, and then contrast them with facts and statistics about the healthcare in the United States. If this does not generate feelings of gratitude towards our healthcare system, then nothing will.

            The first achievement is that of the the founding principle of the National Health Service and the basis upon which it was raised; the idea that healthcare is based on need and free at the point of delivery. It was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. This has remained consistent since 1948, with the exception of some charge, such a prescriptions, optical services and dental services. This means that the 64.6 million people living in the United Kingdom have access to a healthcare system whatever their economic or social background. In contrast, the average American spends $10,500 a year on healthcare, with that figure looking to reach $15,000 by 2023. A study in 2013 indicated that, despite spending well in excess of any other countries looked at, the United States achieved worse outcomes in rates of chronic conditions, obesity and infant mortality. The countries studied were Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

            Not only was the U.S Government spending around double per person on healthcare in the US compared to the UK, that money was only for Medicare and Medicaid benefits for disadvantaged and aged people. In almost all aspects, the United States charged more for tests and procedures. There is a discrepancy in that this study was undertaken before the invention of Obamacare. Obamacare may have been a catalyst for improvement in the United States healthcare system, however what was one the the first actions of Donald Trump on achieving office? Scrapping Obamacare.

            The second greatest achievement is the comprehensive childhood vaccination programme put in place by the NHS. This programme has been crucially important in saving children from diseases such as measles, mumps, meningitis and polio. Not only does this allow all children protection, it also gives rise to herd immunity, the idea that if a high enough proportion of individuals are immune to the disease, the remaining population without the immunity will be protected. In contrast, not only does the US not have a scheme like this, children unable to be vaccinated because their parents are unable to afford it, face the risk of decreasing the herd immunity effect and such diseases which are so easily preventable may be scarring and have a detrimental affect on a child’s health and well-being.

            The third is the idea of General Practice as the foundation for patient care. General Practitioners are fundamental to our healthcare system. They are the cornerstone of the NHS that provides a direct link between a practise and its patients, rooted in the community. They are able to treat all common medical conditions and refer patients to hospitals and other medical services for urgent and specialist treatment. Unlike hospitals, they can focus on the health of the whole patient, combining physical, psychological and social aspects of care. Again the United States falls short. In the US, primary care (the first contact a patient sees with a doctor) is provided by specialists. This has driven up the cost of care in the United States enormously and encourages more defensive medicine, to reduce the risk of litigation. Another disadvantage of going straight to a specialist is that their specialist knowledge may not be able to identify the root cause of the patients suffering, simply by having more extensive knowledge in a certain area, rather than a more comprehensive knowledge overall.

            It is for all these points that I truly believe these three to be the greatest achievements of the NHS at 70. Since birth, the NHS has grown and developed into something of which we can be proud. I would like to conclude by pointing out one further difference between the UK and the US; the NHS is Britain’s largest employer, employing over 1,635,000 people throughout the whole of the United Kingdom. Comparably, the United States largest employer is the Department of Defense, employing double this number at considerably greater expense. Clearly, the United States has different priorities.