The healthcare system in the UK is split into private and public services. It is important to understand each of these, specifically their advantages and disadvantages, and most importantly, why someone would select one over the other.
In the private healthcare system, you are required to pay for services entirely yourself either through private healthcare insurance or directly to the private healthcare company. There are private hospitals, private GPs, private clinics and private healthcare plans, for example, Bupa.
Public healthcare services are available through the National Health Service (NHS) in the UK. It is free at the point of need and is funded through the tax system. This means that the cost of the resources is covered by UK taxpayers. Again, there are a number of services that fall within this category, such as hospitals, GP surgeries, clinics, dentists, opticians and pharmacies.
The key difference between the two types of systems is that anyone can access public healthcare and not pay a fee for the services they provide. That means anyone can afford to go. Whereas, the private healthcare sector is only limited to those who can pay for the services they can provide. Therefore, it is not accessible to everyone.
Prior to the formation of the NHS, particularly during the Second World War, there was widespread agreement that the current healthcare system needed to be revolutionised. Many people were struggling due to rationing, the loss of loved ones and the instability of the economy. Therefore, in 1946, The National Health Service (NHS) Act was brought to the parliament.
The NHS Act led to the establishment of the public healthcare system in the UK known as the National Health Service (NHS). This was formed on the 5th of July in 1948, shortly after the end of World War II, by The Minister of Health at the time, Aneurin Bevan. The aim was to provide all the resources and free benefits to all those who needed them.
Since the formation of the NHS, which was 74 years ago, many factors have changed which have had an impact on how the NHS functions. These include the following:
1. Patient’s paying for services. The NHS was once free at the point of need meaning everything was paid for by the budgets set by the government. However, there are many services now where the cost must be covered by the patients themselves unless exclusion criteria apply. This includes prescription costs, dental care and eye care. These costs are subsidised by the government to ensure they are still affordable to the patient. Please note, this applies to NHS England, with some areas of the UK such as Scotland which still provides free prescriptions, dental and eye care for the majority.
2. Ageing population. In the 21st century, more people are living longer than ever before and technology and research advancements contribute hugely to this. However, this has increased the number of people who may need to access the NHS. This has caused issues in areas such as hospital capacity which will be touched upon in more detail later.
3. Political changes. The NHS was formed under a Labour, left-wing government. Currently today, the UK is under a Conservative government. Naturally, there are differences in the views of the two leading parties and hence, their leadership does have an impact on the NHS. There is a long-standing debate regarding the funding of the NHS, a significant problem currently facing the NHS.
4. COVID-19. Unfortunately, the pandemic has had a negative toll on the NHS. Many individuals have been admitted to hospital due to the infectious disease, and others have been unable to access healthcare because of COVID-19 priorities. This has led to a backlog of patients needing treatment and support, as well as patients needing much more intensive care due to late presentation of their condition. This has not only changed the way the healthcare system is run, for example by increasing the number of remote appointments and introducing more protocols to reduce the risk of transmitting the virus, but also led to an increase in pressure on the NHS over the last 3 years.
5. Funding. As touched on when discussing political changes, the NHS is facing hardship due to a lack of funding. There are more people requiring care and finite resources at the disposal of the NHS. Hence, this has led to the introduction of various guidelines, for example allowing a patient a certain number of missed appointments before being automatically discharged from the hospital, introducing some fees, and making cuts on hospital transportation. This has led to the debate of whether the NHS should become semi-privatised.
1. Affordable. The way that the tax system is organised means that those who earn the highest have to contribute more. This money is then used to benefit everybody for example many of the services and treatments available to patients are either free or heavily subsidised. This prevents discrimination on the grounds of socioeconomic background or percentage of contribution through the taxpayer system.
2. Accessible. Public healthcare services are more widely available than private and can be accessed by anyone.
3. Regulated. Being a government-run organisation, the NHS has rules and regulations. In contrast, the private sector is highly specialised and if an emergency arises, then the NHS is more equipped to deal with the matter than private healthcare. A certain high standard must be met and if this is not for any reason, then the matter is thoroughly investigated. Because of this, there is a safety net for its patients and therefore that level of trust is developed as well.
1. Too widely accessible? Because the NHS is accessible to anyone and is facing several issues related to funding and staffing, there are longer waiting times and waiting lists for treatments. For example, patients often have to wait in A&E longer than the 4-hour target, wait over a week for GP appointments, and routine surgeries may be delayed. This can be very frustrating for patients. There may also be individuals who try to use the services without a legitimate reason or for very minor ailments.
2. Finite resources. Unfortunately, the demand for the NHS exceeds the supply of finite resources available. This can also be partly due to funding through the tax system. Hence, there are ongoing issues and debates regarding the financial situation of the NHS. Lack of resources includes the lack of healthcare staff such as doctors and nurses. In addition, hospitals frequently reach full capacity which means not enough beds for patients.
3. The workload for healthcare professionals. Many healthcare professionals are overworked due to the limited number of staff. This reduces their work-life balance and job satisfaction. This has a negative impact on the NHS because people leave to work in other countries or work privately because of better career prospects and work-life balance. Additionally, some argue that the volume of work is disproportionate to the amount healthcare professionals are paid, hence the discussion of nurse and junior doctor strikes in the near future.
4. Political decisions impacting the NHS. The NHS is regulated by the UK government. This means that a set group of people are in charge of the decisions made for the service. As with all decisions, they do not cater for all of the people that they will impact. Agreements and disagreements during decision-making can negatively impact the service which has a downstream effect on the patients: the quality of the service is reduced and there is a loss of the patient's trust.
1. Quick provision of treatment. If patients are unable to access their treatment on the NHS due to long waiting times, then most likely, private healthcare will be much quicker when it comes to receiving treatment. This is often an appealing factor for patients who want to have a speedy recovery from their health issues.
2. Payment plans. This option is ideal for people who cannot afford to pay for treatment in one go. They can pay in instalments. This idea is appealing to many people which is why many consider private healthcare treatments. Usually, people who use private healthcare also have health insurance which enables them to access many treatments quite easily and often covers the whole family rather than a single individual.
3. Greater choice. This includes many things such as treatment options, treatment plans, aftercare choices and facility choices. They are more likely to consult with a physician of their choice as well as really take control of their treatment options. Often, this puts a lot of patients at more ease.
1. Lack of regulations. Private healthcare is not under the same rules and regulations as public healthcare. Therefore, its lack of regulation can become a reason to exploit potential and current patients, for money and/or fame. People need to be educated on doing their research and coming to an informed conclusion to minimise this risk. This is a trap that many patients may fall into out of desperation and urgency. Sometimes, people in the private healthcare system are not even competent in the procedure the patient wishes for them to perform. Unfortunately, some clinicians in the private healthcare system do not care about this.
2. Costs. Private healthcare is not something everyone can afford, even with payment plans. Private healthcare insurance is also very expensive. Hence, this creates a divide on who can access this type of treatment. This can leave patients that are unable to pay worried when they must resort to the NHS which will take longer to provide the care that they need. Doctors may even exploit wealthy patients by making them do tests that are unnecessary and exploit them based on their lack of knowledge.
3. Not everything is covered by private healthcare This includes emergency treatment which is covered by A&E on the NHS, chronic illnesses, certain medications and perhaps pre-existing medical conditions a patient may have. The lack of diversity and specialisation in certain fields makes private healthcare less effective for many patients.
Let’s take a scenario. A girl has broken her nose in an accident. She gets this operated on under the NHS but is unhappy with her look. Under the NHS, either they may not take this issue forward since it’s a “cosmetic issue” or she will have to wait a long period of time for treatment to fix this.
The girl does not want to wait and explores her options. One of these is private healthcare which is offered either in the UK or abroad such as in Turkey. It is much quicker and seems more appealing with the facilities and expert clinicians. She, therefore, decides on the private option since she is able to pay the bills.
The above example is quite common and hence, people choose to go private due to time, the fact they can afford it, and the fact that the services are advertised to make it appeal to what the patient wants.
Understanding the difference between the public and private healthcare systems, and the advantages and disadvantages of each, is not only important for your interviews but also for your career as a medical student and later doctor. As both systems are constantly evolving, it is a good idea to keep up to date with the changes being made.
Author: Iqra Ali
Editor: Allegra Wisking