Britain’s NHS came in for rave reviews in a recent study that compared healthcare systems in several European countries and the Anglosphere. There was, as John Kay points out, only one minor flaw in the way the measurements were weighted:
“NHS is the world’s best healthcare system” was a headline last week in The Guardian newspaper. However, six paragraphs in, the authors observed: “The only serious black mark against the NHS was its poor record on keeping people alive.” Further investigation was clearly required.
The newspaper was reporting a survey of health provision by the US-based Commonwealth Fund in 11 advanced countries: seven European states, the US and Canada, Australia and New Zealand.
The findings use measures of service quality, mainly derived from judgments by patients. The effectiveness of care is judged by the intensity of preventive activity – whether necessary tests are carried out, whether doctors advise on a healthy lifestyle – and the reliability of management of chronic conditions.
The safety of care is judged by the frequency of medical mistakes, and the incidence of hospital-induced infection. Good care is patient-centred and timely, with necessary treatment easily accessible. The survey also reports measures of efficiency, or more often inefficiency – how great is the burden of medical administration, how much unnecessary use is made of emergency services, how reliably test results reach medical professionals.
The UK’s National Health Service is at or close to the top on almost all these indicators, and its health spending per head is the second lowest in the survey. The US system scores badly on everything except preventive care, and US medical costs are off the scale when compared with other countries.
The problem, however, is that when it comes to keeping you alive, the World Health Organisation puts Britain tenth out of 11; only the US is worse. If your objective is to live a healthy life, go to France. Medical outcomes are judged by reference to three measures: avoidable mortality, infant mortality, and healthy life expectancy at age 60. And the NHS does not do well on these metrics.
