How does the NHS compare to other healthcare systems?

Woman in wheelchair talking to doctorBritain's free, state-run National Health Service dates back to the immediate post-war period and is funded by taxpayers. With a budget of more than £100 billion, the NHS is the largest publicly funded health system in the world.

Only about one in 10 Brits have private health insurance. The drawbacks are that there are long waiting lists for certain types of surgery.
However, reforms cooked up by the Tories will increase the role of private companies in the NHS and radically change the way healthcare is provided. Controversially, hospitals will be allowed to get half their income from private patients. There are even plans to ask credit rating agencies Standard & Poor's, Moody's and Fitch (which failed to spot the credit crunch) to vet the financial strength of hospitals.

Family doctors will be empowered, with £60 billion of NHS buying power passing to them. This means that some (e.g. in Hertfordshire) are now asking obese patients to lose weight, or smokers to kick the habit, before considering them for surgery. Under the reforms, patients will be given a choice of healthcare provider. That sounds like a good thing. But can there be too much choice? For example, in Nottinghamshire, there are now 14 different providers of NHS-funded physiotherapy.

Writing in the Guardian recently, Dr Aseem Malhotra, a cardiology specialist registrar, sharply condemned the reforms. "Instead of GP-led primary care and consultant-delivered hospital services we will witness 'any willing providers' picking up the most lucrative operations, with the NHS left to provide complex, costly care. There should be absolutely no illusion that we are being led towards an Americanised system of healthcare."

How do other countries provide healthcare?

United States
Most Americans get private health insurance through their employer via salary reductions, so if they lose their jobs, they are left without cover. But thanks to Barack Obama's healthcare reforms, the uninsured and self-employed will be able to buy cover from state-based exchanges from 2014.

The federal government is involved in two main schemes, Medicaid and Medicare, which each cover about 13% of the population. Medicaid is jointly funded with states and targets certain low income and vulnerable groups – e.g. children and the disabled. Medicare is mainly aimed at those over 65.

Obama's reforms expand coverage to 32 million Americans who are uninsured because they can't afford rising premiums or who are considered too sick by insurance companies to qualify. From 2014, most Americans must have health insurance or face hefty fines. Insurance companies will be prevented from dropping people when they fall ill, and won't be able to deny coverage to those with pre-existing conditions. Higher premiums for women will be banned.

The reforms also aim to close the "donut hole" - which affects millions of over-65s who rely on Medicare. People have to pay if their prescriptions cost more than $2,700 and only qualify for coverage again if the cost passes $6,154. The legislation will give people rebates and discounts on brand name drugs.

France has been ranked first by the World Health Organisation's survey of healthcare systems in the past. The country provides universal public health coverage for all 64 million residents, including those in French Guiana, Guadeloupe, Martinique, and Réunion. The scheme is funded by social health insurance contributions from employers and employees – with no option to opt out.

The French can consume as much healthcare as they like, but they pay upfront and do not receive full reimbursement. Most people take out extra private insurance for areas that are not covered by public health insurance. France has about 4,000 hospitals, a quarter of which are public.

Germany has the world's oldest universal healthcare system, which traces its origins back to Otto von Bismarck's social legislation in 1883. Despite major reforms in 2007, the basic structure remains the same. Public health insurance is compulsory for people earning up to around €48,000 a year.

The public scheme is operated by more than 200 health insurance funds, and funded by compulsory contributions from employees and employers directly to the sickness fund. It covers nearly 90% of the population. The remaining 10% have private health insurance – mainly civil servants, higher earners and the self-employed. Less than 1% have no insurance.

The Health Insurance Law of 1922 first provided public health insurance to private sector employees, but this was quite limited. Today Japan has broad health insurance coverage, featuring a private delivery system with a public financing scheme. It is funded from a combination of employer and employee contributions and taxes. All residents, with the exception of children, the elderly, and those with certain chronic diseases, have a 30% co-payment.

There are three types of insurance, for employees of large companies and public sector workers, employees of small and medium-sized firms, and the self-employed and retired. People do not have a choice of plan. Premiums vary according to income but entitlements and reimbursement rates are standard. All plans contribute to the elderly care pool.

Sweden is often held up as a model of an efficient universal healthcare system, covering 9 million citizens. Figures from 2002 indicate that, while the US spent $5267 per capita on healthcare, Sweden spent less than half that amount ($2517) yet achieves vastly better health outcomes.

Both health services provision and financing are delegated to regional and local authorities. Private firms deliver only about a tenth of healthcare services, mainly in primary care. The healthcare system is funded from taxes, mostly from local income taxes levied by the county councils.
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