NHS or US private care - which comes out top?

Quality Watch, an independent research programme developed in partnership by the Nuffield Trust and the Health Foundation, has looked at how the UK health service performs compared to 14 other health economies - Australia, Belgium, Canada, France, Germany, Greece, Ireland, Italy, the Netherlands, New Zealand, Portugal, Spain, Sweden, the United States (US). The study took 27 key health indicators, including immunisation rates, antibiotic use, cancer, heart attack and stroke survival and admissions for diabetesasthma and COPD.

There's some good news for the UK. Given recent doomsday scenario headlines on overuse of antibiotics - not to mention how quick the Government have been to blame GPs for dishing them out - it's gratifying to see that the UK has one of the lowest rates of antibiotic prescribing, with only Germany, the Netherlands and Sweden prescribing fewer per head of population. We're also doing relatively well in terms of diabetes hospital admissions, both for complications (long- and short- term) and emergency admissions. We're good at screening for breast and cervical cancer, and our levels of suicide among people discharged after a diagnosis of mental health disorder are relatively low.

But this is very much a curate's egg of a report, and in other respects the UK fares less well than other countries. Our survival rates for breast, cervical and colon cancer are below par. Our cancer survival statistics have long been a concern - in 2009, the Cancer Benchmarking Partnership was set up across 6 countries (Australia, Canada, Denmark, Norway, Sweden and the UK). They have highlighted several reasons for our relatively poor performance, including how cancers are defined. For instance, some cell abnormalities may be defined as 'pre-cancerous' in one country but 'cancerous' in another. These early changes can usually be successfully treated, so pushing up apparent survival rates if they're included in statistics. But this doesn't account for all the difference by any means, and it's in an attempt to tackle these issues that NICE has produced new guidelines on cancer.

The UK has historically spent less on healthcare than many other countries. In this study, we're in the bottom third of spenders per head of population. The US spends almost two and a half times as much on healthcare per person as the UK. The US is the best country of those surveyed in terms of cervical screening, but doesn't top the charts in any other respect. So it's not just a question of how much money you throw at a problem.

Having said that, money does provide services - and the UK doesn't have many of those. A new report from the Economics Intelligence Unit points out that the UK ranks 28th in a list of 30 countries in the OECD (Organisation for Economic Co-operation and Development) for healthcare resources. For instance, we have 2.8 doctors and 8.2 nurses per 10,000 population in 2012, compared with OECD averages of 3.2 and 8.9. We have 2.8 hospital beds/1000 patients compared to an OECD average of 4.8, and under half the average number of CT and MRI scanner units.

In case you hadn't noticed, the NHS is strapped for cash. The Government has just announced an extra £8 billion by 2020/21, but the BMA has pointed out that NHS England has calculated that there's still likely to be a £22 billion funding gap by the end of this parliament. This survey suggests we're doing far more with our money than many other countries. But without significant investment, it's hard to see our performance doing anything other than getting worse.

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