The United Kingdom has in many respectsthe archetypal centrally planned, publicly financed healthcare system in the form of National Health Service (NHS),established in 1948 in a time of great austerity afterSecond World War. It is largely funded from generaltaxation, and provides wide coverage of most mainstreamhealth services, with little recourse to user charges. Itoffers strong financial protection against the costs ofhealth care and enjoys high public approval ratings. Itsprincipal shortcomings have been weaknesses in servicequality, often in the form of long waiting times, andsometimes relating to clinical quality. This paperconcentrates on the experience in England, which accountsfor 84 percent of the UK population of 64.6 million. Thesystem of health service coverage adopted in the NHS is verysimple. There is no explicit requirement to enroll in aninsurance plan. Instead, citizens must register with ageneral practitioner (GP) of their choice. GPs act as agatekeeper to nonemergency secondary care and prescriptionmedicines and devices. Apart from small fees for someprescription medicines (from which many citizens areexempt), patients are not directly charged for access to NHScare. Throughout most of its history, the NHS model ofgovernance has entailed strong central control by thenational ministry, with local administration responsible fordetailed local planning and purchasing. The forms of localadministration have varied. In the early years of the NHSthey were primarily local NHS hospitals, with separatecommittees for oversight of primary care. Since 1974, localhealth authorities have assumed the role of oversight oflocal services, currently covering, on average, populationsof 250,000.
PDF
download
878987797
028-85220240
