What the National Health Service (NHS) in the UK covers, and what costs patients extra

Introduction

The National Health Service in the United Kingdom was set up in July 1948 to cover everyone in the country for all health care. It was set up to be free at the point of delivery, and paid for out of national general taxation.

This article is a follow-on from my previous one, The National Health Service in the UK: who pays, and who is covered, which looks at how the NHS was set up, who is eligible for treatment, and how much the whole system costs.

This hub examines what types of medical care are covered by the NHS, including doctors, hospital treatments, dentists, and opticians. It also details what patients have to pay for, such as fillings and prescriptions, how much they cost, and who gets them for free.

It also considers other associated matters, such as assistance for wigs or travel costs for NHS patients.

Different universal health systems in different countries have varying arrangements, as to whether patients pay for visiting a GP, or for hospital stays or long-term drugs.

The NHS is split into four parts, for England, Wales, Scotland, and Northern Ireland. The differences aren't great, but there are some minor variations in terms of payment for prescriptions and so forth. This article is about the rules, regulations and system in England.


The National Health Service Logo
The National Health Service Logo
St. Thomas' Hospital, an NHS hospital on the banks of the River Thames in London
St. Thomas' Hospital, an NHS hospital on the banks of the River Thames in London

Medical care

Medical care - from doctors, nurses, physiotherapists, radiologists, health visitors, midwives, the whole shooting match, is free of charge at all times.

There is no contributory payment. No-one covered by the NHS pays for any visit to any doctor, nurse, health visitor, or other health care professional. There is no additional payment for X-rays, drugs given while in hospital, or any related medical care.

All medical conditions and proceedures are covered. There is no limit to the amount of health care provided to one person over any period of time.

The assessment is on clinical need, not on how much someone has been treated in the past. So treatment for a minor ear infection and a heart and lung transplant cost the patient the same - nothing.

Things such as breast reductions, plastic surgery, gender-change surgery and so forth are provided on the NHS if there is a clinical need for it. So you won't get a nose job because you don't like the shape of it, but you will get treatment for a broken nose, to put it back to normal, or a breast reduction if you are suffering strain on your back.

While in hospital, patients are fed and watered, and this is also free. Although it must be said, the quality of the food isn't that great. I ordered my other half to bring in sandwiches and snacks when I was in hospital after the birth of my son. There is only so much over-cooked pasta and soggy cabbage I can eat, and I reached the limit quite quickly.

King's College Hospital, London, showing the entrance to the Casualty Department, also known as Accident and Emergency
King's College Hospital, London, showing the entrance to the Casualty Department, also known as Accident and Emergency
Another entrance, to the Guthrie Wing, and King's College Hospital.
Another entrance, to the Guthrie Wing, and King's College Hospital.

Prescription Charges and paying for drugs

Drugs given in a hospital or clinic are free. All contraceptive prescriptions are free. All drugs and medicines for tuberculosis, cancer treatment, and sexually-transmitted diseases are free. Drugs given at a General Practitioner's Surgery are also not charged for - so an injection for anything, administered by a doctor or nurse, is free of charge.

The only drugs which patients pay for are those issued for out-patients by a GP. The cost is £7.20 (about $10.80). The charge is standard, whether the actual drug costs £2 or £200 a dose.

A lot of people are exempt from paying for prescriptions. The current NHS list of exemptions is as follows, people don't pay if they:

  • are 60 years old or more;
  • are 15 years old or less;
  • are under the age of 19 and in full-time education;
  • are pregnant, or have had a baby in the previous 12 months;
  • have a continuing physical disability which means a person cannot go out without help from another person.

In addition, people get free prescriptions when they are on benefits when unemployed or on a low income, or their spouse or partner is on such benefits.

That means that more than half of prescriptions aren't paid for. For example, I had free prescriptions until my 19th birthday, had to pay for them from the age of 19 to 27, then had free prescriptions for nearly two years when pregnant and a new mother, and now pay for them again.

If you need a lot of prescriptions, you can buy a pre-payment certificate which costs £104 (roughly $156) a year. So the maximum any person pays for drugs per year is £104. These are useful for people with long-term chronic illnesses.

My sister, for example, suffers from Coeliac disease. She gets quite a lot of different things on prescription, including gluten-free bread, biscuits, and pasta, as well as drugs. She has a yearly certificate.

Great Ormand Street Hospital for Sick Children, an NHS hospital in London, WC1. This is the main entrance to the original building
Great Ormand Street Hospital for Sick Children, an NHS hospital in London, WC1. This is the main entrance to the original building
Great Ormand Street Hospital for Sick Children, ambulance entrance
Great Ormand Street Hospital for Sick Children, ambulance entrance

Dentists and dental costs

The NHS doesn't cover all dentistry for all people.

Everyone is entitled to register as a National Health Service patient with an NHS dentist. There are a set list of charges to be paid as an NHS patient.

Some people get all NHS dentistry free, if they are:

  • are 15 years old or less;
  • are under the age of 19 and in full-time education;
  • are pregnant, or have had a baby in the previous 12 months;
  • are on benefits for unemployment or on a low income, or their spouse or partner is on such benefits;
  • an in-patient in hospital, including a dental hospital.

If you don't get free dentistry, there are set charges for NHS patients. There are 3 sets of charges:

Band 1 - covers an examination, X-rays, scale and polish, fissure sealing, and fluoride varnish;

Band 2 - covers Band 1 plus any fillings, root canal treatment, or extractions;

Band 3 - covers Band 2, plus crowns, bridges, and dentures.

You only pay a Band Charge once for one set of treatment. So if, for example, you visit your dentist for a check-up and hygienist appointment, go back a week later for a filling on one side of your mouth, and back the following week for a filling on the other side, that is one Band 2 treatment. You are also covered for additional treatment within the next couple of months, and for repairing work done for up to 12 months, by the same payment.

As a general rule, orthodontic treatment is free for under 18s, and not for adults. There are some exceptions for adults with particular problems.

At the moment, Band 1 is £16.50 ($24.50), Band 2 is £45.60 ($68), and Band 3 is £198 ($297).

All the above is how it is supposed to work, but in my opinion, the dentistry side of the NHS works less well than the medical side.

Firstly, it's often quite difficult to get taken on as an NHS patient with a dentist, whereas there is never any such difficulty with medical care or finding a GP. Appointment times aren't all they might be, either.

Secondly, treatment is all about "clinical need" not cosmetics. So you can only get metal braces on the NHS, for example, not more subtle white ones.

I've never been an NHS patient for dentistry, but have had private treatment since birth. It seems more hassle than it's worth, as far as I'm concerned. I pay £60 ($90) every 6 months for a check-up and polish as a private patient. I've never needed any fillings or similar, so that's not an issue for me.

An NHS pharmacy / chemist's in central London
An NHS pharmacy / chemist's in central London

Eyecare

People get free eye tests when needed (every 6 months to 2 years, depending on whether the person is healthy etc) if they meet the following conditions:

  • are 60 years old or more;
  • are 15 years old or less;
  • are under the age of 19 and in full-time education;
  • are blind or partially sighted;
  • have glaucoma or diabetes, or are at risk of these, or have a close relative with glaucoma;
  • are on benefits for unemployment or on a low income, or their spouse or partner is on such benefits.

Most of the people who are entitled to free eye tests also get vouchers towards the cost of glasses, if they are needed. The vouchers aren't generous enough to go for designer lenses, though!

The system is easy to use and very simple. You can pay for an eye test, and then claim the cost back if you are entitled to, which is the easiest way of doing it, and also apply for a voucher for glasses.

You can almost always get a same-day appointment, and the test costs about £17 ($25) (that's what my last one cost in London).

These costs are only for testing eyesight and for glasses or contact lenses. Any eye injury, infection or damage is a medical matter, and treatment is free.

An NHS General Practitioner, the Holborn Medical Centre in London, WC1
An NHS General Practitioner, the Holborn Medical Centre in London, WC1

Other things the National Health Service pays for

For certain people,mostly those on very low incomes, etc, the NHS pays for people to travel to hospitals for appointments, pays for people to go with a patient if they can't go alone, and people can make claims for visiting close family members in hospital, too.

People who are on very low incomes, or under 18 or over 60, can also get free wigs, fabric supports, support garments and so forth if they need them as a result of medical treatment.

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45 comments

JamaGenee profile image

JamaGenee 7 years ago from Central Oklahoma

LG, this sounds like absolute heaven compared to the U.S.! Should'e moved to the UK when I had the chance in my twenties!


SweetiePie profile image

SweetiePie 7 years ago from Southern California, USA

The UK sounds like a wonderful place when it comes to health care.  In the United States I hate to say it, but many people go into the medical field hoping to make a very high income.  I have heard in the UK and other countries with universal health care that doctors do not make as much as here in the US, but I am just wondering if that is true.  Sorry for all the questions, but I hear Americans saying many different things about health care overseas, so I am just trying to learn what is real and what is not. 

Even when I did have insurance it did not really cover much, and on top of that I had to pay a co-pay for each visit. The UK system really makes much more sense.


LondonGirl profile image

LondonGirl 7 years ago from London Author

JG - I like the NHS. In fact, ask any British person whether they'd get rid, and I bet 99.9% would look at you as if you'd lost the plot.

Sweetie, sorry to be thick, but I'm not really sure what co-pay is? I don't know what American doctors earn. When my flatmate started as a Junior House Officer (first year after medical school) she was earning about £30,000. That's 5 years ago, now. But doctors don't come out of university so far in debt.


SweetiePie profile image

SweetiePie 7 years ago from Southern California, USA

Hi LG,

Here in the US medical school can be very expensive, but that is because the incomes can be very high when people become established in their careers. One friend wanted to become a physician's assistant and she was going to be making about $70,000 when she graduated, but her course work ran about $150,000. However, given her income she could pay off those loans in several years and be doing very well for herself.

I have heard some doctors here in California make far more than 150,000 per year, but of course that is not everyone. Actually, in parts of the US there have been doctor shortages, and I often had physicians that moved from India to the US because of the economic advantages.

I enjoy watching the show real time with Bill Maher, which is basically a comedic look at the news. He had a good point the other day about how in America many people become doctors to make a good income, whereas in other countries that is not usually the motivating factor.

Doctors that live in our community drive nice cars and live in nice houses, so I am not saying they are all about the money, but the ones who work for those salaries usually would not work at free clinics that pay only a fraction of the income.

Here in the US we have a deductible on our insurance, so we usually have to pay a co-pay for each visit towards the deductible. I could be explaining it wrong as someone in the medical field could explain it better, but all I know is with my HSA insurance I had a $1,000 deductible and I had to pay thirty dollars at each doctors visit towards my co-pay.

Insurance was always some big mystery to me because employers would throw you this big book and say figure it out. When I had private insurance my co-pay was thirty dollars a year for two visits per year, and $5,000 dollar deductible for hospital service. After reaching the $5,000 threshold I had 80% coverage there after. The emergency room was a $500 dollar deductible with 80% coverage there after.

I stopped being keen on insuranace after I paid about $1500 dollars for outpatient services for a back injury, and could have ended up paying all the way up to $5,000 if the hospital had billed more.

Even with an employer I had a 1,000 deductible and an HSA, which was a health savings account that was supposedly tax free. You can use that money for medical expenses towards your deductible, but what they do not tell you is the money deposited in this account is added to your income if you do not use it, and then you have to pay taxes on it each year!

I am sure cobra and other employer insurance where people pay between $300 and $700 per month covers more, but what is the point? I see the entire medical field here in the US as being way too driven by profit, so I refuse to have insurance right now.

I know that is a little cavalier because I could get in an accident, but I think paying $100 dollars a month for a $5,000 deductible is do-do, and I refuse to pay for the cobra which are the $400-$700 dollar plans. Of course some one from a medical field could explain this better than I, but what I do know is medical insurance here is a rip off.


Elena. profile image

Elena. 7 years ago from Madrid

Hello, LG!  What a sum up, well done girl! 

Spain is pretty much the same, down to a "boob job" if it's clinically justified.  Some regions (health care depends on the Autonomous Communities) even cover for treatment such as sex change IF it's clinically and psychiatrically diagnosed that the person needs it.  Plus, any kind of transplant, cancer treatment and any other sophisticated medical services are all at the cost of ZERO euro at the time of service.  Evidently, as you, we are taxed for social security, but only if we are above a certain revenue/year.

There are variances with dentists. We don't need to pay extra, but we can't expect to get a fix anytime in the century either unless it's something really urgent.

Prescriptions, transportation to health care centers of disabled or old people, etc. all the same.  OK, no point in repeating all you so wonderfully explained :-)

I guess I just wanted to say, we live in a paradise compared to you know who!


Sufidreamer profile image

Sufidreamer 7 years ago from Sparti, Greece

Great Hub, London Girl.

Surely the NHS food is not that bad! My partner worked as a cook in a small hospital, and the food was excellent. In Lancaster, they actually make money by opening the canteen to the public for a cheap but good meal.

Mind you, the Oxford John Radcliffe............everything has the texture of cardboard :D

We have a very similar system in Greece - we pay social insurance every month, about $100 to $200. This covers pension payments and health cover, including everything except dentistry - like UK National Insurance. The hospitals are generally very good, and never turn anybody away - I know a couple of US tourists who fell ill, and the hospital did not even ask for insurance documents. :)

Elena - The Mediterranean life really is tough - how do we do it?


LondonGirl profile image

LondonGirl 7 years ago from London Author

Thanks for your very detailed reply, Sweetie. I had a quick look at the BBC website, and that reckons the average GP (General Practitioner, the normal family doctor first port of call) earns £104,000, say about $150,000, which seems a pretty decent salary to me. I don't think most people would complain about that level of income.

It appears to me that your deductable thing is like what we call "an excess" on car insurance. I pay a bit less on my car insurance every year, and in return, I pay the first £250 of any damage caused by me for which I make a claim on my insurance. I'd hate to have it applied to health care, though. If, say, you were a family of two adults and 2 children, with the $5,000 excess you mentioned, you'd potentially have to pay out a fortune in medical bills before you got anything paid for.

It also sounds like a very complicated system. All that administration and organisation must be very inefficient, I reckon.

I can understand why you feel that paying $100 a month for a $5,000 excess is a rip-off, but it must be a bit concerning at the same time not having insurance. I think we are very lucky in the UK.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Elena, sounds as if your system is very similar to ours - does the health care network as a whole command popular support?


LondonGirl profile image

LondonGirl 7 years ago from London Author

Maybe some of it is great - I haven't done a nationwide tour, Sufi! All I can safely say is that the food was pretty dire in the Elizabeth Garrett Anderson Maternity Hospital.....


Elena. profile image

Elena. 7 years ago from Madrid

Yes, LG, as a whole it does. There are always complains of delays to get your turn with a specialist, of busy emergency rooms, and such, but in general the people support it. There have been (and will be more, I'm sure) some attempts at privatizing in Autonomous Communties where conserv Gobs prevail, but the majority of citizens support the philosophy of all individuals regardless of income having a right to health care.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Glad to hear it. I feel quite strongly that access to healthcare should be universal, and that people should not have to be worrying about the cost of breaking an arm, or their children getting an ear infection.


Sufidreamer profile image

Sufidreamer 7 years ago from Sparti, Greece

The same with the Greeks - if the government tried to privatise healthcare, parliament would burn, and the media would have a field-day.


Elena. profile image

Elena. 7 years ago from Madrid

Me too, LG - I think healthcare and education are basic human rights. Among others, of course, but if there isn't heath or education (never mind food...), then what's the purpose of other rights. Kind of. You know what I mean, I'm sure.


LondonGirl profile image

LondonGirl 7 years ago from London Author

I think, Sufi and Elena, that we are three minds with but a single thought!


SweetiePie profile image

SweetiePie 7 years ago from Southern California, USA

I do wish I had insurance, but right now I am just trying to save money. I would prefer a system like that of the UK personally, but I really do not want to have to pay for insurance on the side when others have employers that do so for them.

One way American businesses have always loved to save money by hiring part time workers, which means no benefits such as insurance. I continue to look for a better full time job, but I never really hear back from anything.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Good luck in your job hunt, hope you get something good soon.


countrywomen profile image

countrywomen 7 years ago from Washington, USA

Very good article. In US the health care seems to be only for those who can afford. Although myself and my husband both get total coverage by our company health insurance but I sometimes wonder what the scenario would be for those who are poor. US is a good country as long as one is healthy and wealthy. I mean the taxes aren't that high and the savings tend to be good(for the standard of living the cost of living is less) but overall if one wants to retire here then it doesn't seem to be the right place. One of my colleague once told me that he would like to take up Canadian citizenship and retire in Canada.

One of the reasons the health care in US seems to be so expensive could be due to high salaries of Doctors(like 200k PA) but then they have to be wary of things like malpractice insurance too. I don't know much about health care in general but your hub makes me feel UK has a better system for everybody. I have a quick question about the waiting times for any procedures which aren't emergency and how they prioritize? Thanks for the wonderful informative hub.


LondonGirl profile image

LondonGirl 7 years ago from London Author

I think it's important to have healthcare freely available.

Waiting times have come down a lot over the last decade, but for non-emergency and not-so-serious stuff (say, a frozen shoulder) there is a delay in seeing a specialist doctor.


countrywomen profile image

countrywomen 7 years ago from Washington, USA

Thanks, LG. I guess sometimes when we really want to expedite(and maybe even willing to pay to get in front of the line) then it would lead to other unwanted fall outs like partiality or corruption. But then I totally agree that health care should be a fundamental human right. I was watching a program where bankruptcy filing due to medical bills is pretty common in US.

At the same time US may not be as "rich" as some may consider it to be. And being the third most populous country on earth has its own share of problems. Any talk of Universal health care gets labeled as "socialist" or "liberal" agenda here when in fact it is a basic human right. I guess some of us can live with a little lesser salary i.e., paying higher taxes, and then hopefully the government would consider it as a basic human right for all. Here some people have too much greed and some don't even have basic need. Ah well, Enough with my ranting.  Have a good day.


LondonGirl profile image

LondonGirl 7 years ago from London Author

There is nothing to stop anyone paying privately for any medical procedure if they want to in the UK. Some people, for example, pay for private maternity and childbirth care. Or plastic surgery. Or anything they want, really!


countrywomen profile image

countrywomen 7 years ago from Washington, USA

UK seems to have a good system. You are right a parallel system seems to be the best compromise. President Obama has promised some things during elections and hopefully something would be done for millions who are uninsured/under insured hence severely at risk.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Let's hope he does.


James A Watkins profile image

James A Watkins 7 years ago from Chicago

Someone above made the outrageous statement that health care here is "only for the rich."  What utter pap.  NO ONE is denied medical care regardless of ability to pay.  In fact, we spend billions on medical care for illegal aliens and when their children are born in our hospitals we pay for that, too, which automatically makes them US Citizens, unlike in the UK. 

Another reader talks about "scare tactics" to make us afraid of socialized medicine.  How about scare tactics to steal our Liberty?  While I do know people who have had their credit ruined by catastrophic illness when uninsured—and that needs to be corrected—their credit is only ruined, of course, because they were treated; otherwise they would be dead and credit would not be an issue (or at the least: you can't have unpaid hospital bills if the hospital refused to treat you). 

But, your Hub has excellent information and may help us make an intelligent decision over here.  I learned a lot about how it works over there.  Thanks!

 


CennyWenny profile image

CennyWenny 7 years ago from Washington

Countrywomen-I work in a law office that does bankruptcies and many of our clients have medical bills that comprise part of their financial woes. Heck, I have a friend whose appendix burst right out of college and who had to file medical bankruptcy.

James Watikins-It may seem drastic, but sometimes I think I'd rather be dead than have ruined credit. It can hurt your job hunting (employers check credit scores), impact your ability to find shelter (landlords do credit checks, not to mention mortgages), forget about getting a car or personal loan. When I was without health insurance for a while I told my husband to just roll me in a ditch if we got in a car accident, he'd like his next wife better anyhow:)

I'm jealous of how little your dental prices are in the UK! I have dental insurance...BUT. They only cover cleanings the whole first year! So, my husband had six cavities filled for a whopping total of $775. So, I pay $70 a month for him to be insured and get about $150 in coverage for the first year which costs me $840. I think I'd rather pay the dentist directly at this point.


LondonGirl profile image

LondonGirl 7 years ago from London Author

James, is all medical care covered? If I am an American citizen who doesn't have either insurance or a large pot of money, and I get cancer, do I get chemotherapy, radiotherapy, operations, all the rest of it, for free?

Or I need a kidney transplant, is that paid for, too?

We don't have a citizenship-by-birth law here, you are right. You are only a UK citizen by birth here if your parents or one of them is either a UK citizen, or has some form of permanent right to be here, such as Indefinite Leave to Remain.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Cenny, I saw an article last week in which it said that 60% of American bankruptcies are caused by medical bills, or medical bills are a large proportion of the debt. That does seem to indicate a problem.


SweetiePie profile image

SweetiePie 7 years ago from Southern California, USA

James I have noticed you like to imply people who do not agree with you make outrageous and ridiculous statements, but maybe these are just a difference of opinion. Having your credit ruined because of medical debt is no small thing.

A friend's father was denied a high level contract position because his credit had been ruined due to hospital bills. If you want to rent or buy a home, or even buy a car people do look at your credit. I have even heard of cases where people were harassed by collectors because of unpaid medical bills.


James A Watkins profile image

James A Watkins 7 years ago from Chicago

Yes.  My poor sister, at 46, has nothing.  And she has stage 3 melanoma.  She was sent to the finest cancer center in Florida for surgery and is now having one year of chemo.  She isn't paying for anything.  She can't.  She has no money, no insurance, no medicaid, no medicare.  Now, they will bill her, and she won't be able to pay, and it will wreck her credit.  She could care less.

Comment on the 60% of bankruptcies. I don't know if that was ever true or not but today it is home foreclosures causing the bankruptcies.


James A Watkins profile image

James A Watkins 7 years ago from Chicago

SweetiePie!  Fancy meetin' you here.  I might not have been lucid in my comment. I did mean to say that the "credit problem" needs to be corrected. 

On the other issue, I only calls 'em as I sees 'em.  And if somebody acts people are dropping like flies in the street because the doors of the hospital are barricaded against the poor, I will call it an outrageous and false claim.  Only cuz—it ain't so. :D  Nice to see you again.


SweetiePie profile image

SweetiePie 7 years ago from Southern California, USA

James,

The funny thing is no one said that Americans are dropping dead because they cannot afford optimum health care, but in all truth low income patients waiting at county hospitals often die in the congested waiting rooms.  Would this happen to a wealthy person? No, because they could afford the top team of doctors to intervene right away.  So just as you call it as you see it, I had to point out this fact.

Hospitals will not turn away low income people, but they will not receive top notch of treatment as would someone who has a good insurance plan.  Do I think universal health care will come to the US right away?  Probably not, but if the UK was forward thinking enough to implement it in 1948, thrn the US is behind the times. 

If your sister does not care about creditors hounding her day and night because of hospital bills that is her business, but for many of us that would be very irritating. Honestly your sister deserves better than a system that will treat her but ruin her credit.

 


James A Watkins profile image

James A Watkins 7 years ago from Chicago

SweetiePie—Obviously, I meant she doesn't care as she faces possible death from stage 3 melanoma. You make very good points, as always. I will just point out that it wasn't that we were behind the times in 1948. The UK was ravaged by war in their homeland; we weren't. The root of their system is clearly this fact historically. Have you heard about the health care crisis we had here in the 1950s? There wasn't one.


Tom Rubenoff profile image

Tom Rubenoff 7 years ago from United States

The chief difference between health care in the U.K. and health care in the U.S. Londongirl, ssems to be that in the U.K. it is a service and in the U.S. it is an industry. The primary function of a service is to help people while the primary function of a business is to make money. Personally I feel that health care decisions should not be business decisions.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Are you sure, James? When the NHS was set up, a lot of doctors found themselves dealing with long-term and debilitating conditions that people had put up with for years as they couldn't afford medical care. A lot of women had badly prolapsed wombs, for example.

Tom - I agree. health care ought to be a service.


mulberry1 profile image

mulberry1 7 years ago

Another great hub, glad to learn more about NHS!  Our costs here are high, but unlike others who talk about the salaries of physicians and so forth I don't see that as the primary problem. Except in a few specialty areas, Drs. here work unbearable hours OR are, at a minimum, constantly on call,  few of us would be willing to give up our quality of life to do what many of them do, nor to put up with the rigorous training, the potential for lawsuit, ongoing education, etc. I feel they earn their pay and I don't begrudge them that!  After all, if you compare factory workers here versus many other places, wages are higher there too. Brainy people will tend to go toward some money, if we want good physicians etc. there needs to be good pay and something needs to justify the level of responsibility they carry. I don't mind paying people what they're worth...

Anyhow, the cause is inefficient systems, insurance (which is a non-value added cost of huge proportions), and so forth.


LondonGirl profile image

LondonGirl 7 years ago from London Author

I agree, insurance and admin costs seem to add an awful lot to American health costs.


Mike from Madison 7 years ago

The UK and other European systems are funded by very high social security taxes.  In the UK, the employer portion of social security is 10% of total salary, bonus, stock options, etc.  In France, the employer rate is around 25% of total income and the employee rate is around 12% (with a very complicated formula).  In every European country other than Germany, the tax burdens are similar. In the US, the rate of tax for medicare is only 1.45% each for employees and employers. So if the US were to implement a similar system it would result in a HUGE tax increase on both employees and employers - much more than the savings that would be achieve by the elimination of insurance premiums.  What makes the funding side of such a change truly scary is that the European systems already have much lower costs for doctor / nurse compensation, administration (e.g. no insurance company salaries, advertising, profits, dividends, etc..., and much lower malpractice costs.)  Its very easy to say medical care is a "right", but the hard fact is that it still has to be funded by the people who benefit from it.  I also wonder about the quality of people that would be attracted to a medical profession with a significantly decreased financial reward - particularly after for investing 10 to 12 years in medical school and specialised training.

Transitioning to a European type system is simply not feasible and it isn't even a part of the discussion going on right now.  Biggest reason - no politial courage for such a huge tax increase and because members of the medical professional would never go along with the drastic pay reductions it would require.

That being said, until some of those hard issues (e.g. malpractice awards, physician compensation, insurance company admin costs)are addressed - we will not see any meaningful dent in our medical costs - or on the risks to the unlucky people who have medical issues that bankrupt them.


LondonGirl profile image

LondonGirl 7 years ago from London Author

Our health system ends up costing an awful lot less than the USA's does, though. In total, the UK spends about 8% of GDP on health care, America spends 17%. That indicates there are massive savings to be made with a unified system, I reckon.


Ian Mottram 7 years ago

i am british 7 yrs ago jcb knocked me off my motorbike cut me in half an nearly killed me. now i can walk talk and do normal everyday things.

whatever the cost the nhs saved my life as they do many others and i am greatful it is there.in other countries i would be dead.


ryankett 7 years ago

Dentistry is the one thing about the NHS that I am not happy about, something needs to be done about that... its almost as if people have been forced into privatisation through a lack of suppply. I have a friend who is opening a private surgery somewhere down south... he has a decent enough solution. Him and his fiancé will perform the private work, thus making them more money, whilst the other 4 chairs in his surgery will be made available at low cost on the provision that those dentists only do NHS work. It is likely that those dentists will do NHS stuff for a few years before going private, but my friend gets to make lots of money pretty ethically...


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LondonGirl 7 years ago from London Author

Generally speaking, we Brits seem to think the whole NHS idea is a great one, with, of course, things that need tweeking round the edges.


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Pseudonymous 6 years ago

A bit late to the party on this one, but this a really great hub, very informative. I agree that on the whole the NHS is something that we are proud of, though of course we love to moan about it too!


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Watch Tower 6 years ago from New Zealand

New Zealand is also similar to the British system. In fact it was the first country in the world to set up such a system, along with what is commonly known as the unemployment benefit, which has since growing to cover. Single parents ( normally mothers) with children, sickness and other services. This Means that should you be unemployed, are sick and can not work you can apply to receive a weekly payment. this is All covered by our taxes, as well as like Britain we have a free full cover health program. The food here in hospital is over all pretty good. You get a menu of the next days planed meals and can then pick which combo meal you would like. Of course the menus are made up to the individual patient allowed food. The Doctors work long hours as do the nurses, and are problem under payed for what they have to do, so many leave to go to Britain and other countries, thus we lose some of the best nurses and Doctors.However more and more U.S.A citizens are no opting to travel to New Zealand for surgery that is simply to expensive in America. Its cost is generally with travel, accommodation etc about quarter of the price and thats going though the private health care, as opposed to the N.Z citizens public health care. So like Britain we in many respects have the best of two worlds, if you can afford it you can got Private health care if not the public health care system will catch you. Even given the fact many leave for over seas jobs to pay student debt we still have one of the highest rated health care systems in the world


Ruby J Jones profile image

Ruby J Jones 6 years ago

I am a bit late to this. But I am very glad for this hub. Here in America we a facing a meltdown match between everyone on our health care system. I personally don't have insurance as the price is too high for me, but at the same time I don't believe OUR government needs to take it over. Though if they COULD follow UK's system it would be nice. I pay as I go, like I have to go to the doctor at the end of the month and it will run $200-$300 just to walk in his door and that is if he don't write any perscriptions! Ummm.... that is what I am going for! Clearly our system needs an overhaul but the politicians are not looking in the right area. If they would overhaul their own spending and quit funding stupid things with our tax dollars that we already pay, then that money could be used to implement a system like yours. Instead they want to tax us more and then fine us if we don't buy into the insurance companies plans, either the private sector or the government one. We are getting way to much control over here and nothing in return.


Dylan Dark 6 years ago

Here in Texas we have emergency rooms that routinely have a 10+ hour wait to be seen, even for those with health insurance ... and sometimes a MUCH longer wait than that (BTW, I was a nurse in the hospital of which I am referring)


Moon Daisy profile image

Moon Daisy 6 years ago from London

A great hub. It makes me realise just how lucky we are to have the NHS and all the things that it entitles us to.

I used to pay for private healthcare but could no longer afford it. This worried me at first, but soon I realised that I didn't really need it anyway (and I could have saved thousands over the years if I'd realised this earlier!). But not being able to pay for private healthcare in the US sounds like a very frightening prospect indeed.

I've also always been reasonably happy with NHS dentistry. I think I've been fortunate that in my area there doesn't seem to be a shortage of NHS places. But £60 for a private check-up and polish doesn't seem too excessive either.

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