What are the major challenges facing UK’s health care system?

The English government determines how expenses are reimbursed, negotiates salaries and contracts with its 1.4 million NHS employees, and limits the availability of expensive technology through the National Institute for Health and Clinical Excellence (NICE).  NICE is a controversial body. At its heart is the Center for Health Technology Evaluation that issues formal guidance on the use of new and existing medicines based on rigid prospective economic and clinical formulas (Evans, 2009).

For some, NICE is fundamentally discriminatory through its use of the quality-adjusted-life year (QALY) to assess cost effectiveness (Hoey, 2007). NICE has repeatedly tried to stop breast cancer patients from receiving the powerful breakthrough drug Herceptin and Alzheimer’s disease patients from receiving the drug Aricept, Galantamine, Rivastigmine, and Memantine (Evans, 2009; Anonymous, 2006). According to The Daily Telegraph (2001), NICE deliberately restricted the state – insured sufferers of multiple sclerosis from receiving the innovative medicine Bata Interferon (cited in Evans, 2009). Similarly, in 2008, patients with kidney cancer continued to be denied effective treatments designed to prolong their lives (Lorens, 2009). Despite all of the complaints, the citizens of England remained supportive of their health care program, according to a survey by the Commonwealth Fund International (Mundell, 2004).

No other country has adopted the British system, not because it didn’t work but because other countries came to universalize health care under entirely different circumstances (Dixon & Robinson, 2002).

What can the United States learn from UK?

Many of the top policy makers in Washington are fearful of the impact of the rising costs of Medicare, Medicaid and the highly regulated arrangements of the private insurance sector.  Increasingly, the policy makers are attracted to the idea of one body that would make top down pronouncement on the cost-effectiveness of the new medical technologies.  In essence, this statutorily created body or agency will be in-charge of containing and rationing medical services and technologies. This implication of rationing is very alarming to the American public (Evans, 2009).

In the same survey by the Commonwealth Fund International, the majority of Americans are dissatisfied with their health care. However, despite of all of the discontent, a large majority of Americans continue to reject the idea of a government mandated socialized medicine. Many are fearful that the quality of their health care will be diminish, fear of long waiting lines, a lack of specialized care, and rationing will accompany socialized medicine (Mundell, 2004).

Kerr & Scott (2009) suggested imitating the British system of gate keeping.  According to them, the jewel in the NHS crown is its primary care and general practitioners. These highly trained GPs contribute to UK’s health by focusing on the whole person rather than on a single organ, emphasizing prevention and health screening which should reduce the life expectancy gap between the rich and the poor.  However, Kerr & Scott do not approved of the controversial role of NICE’s role in “postal-code lottery of prescribing” which was described previously as discriminatory.



 Cesar Aquino, PhD, MBA, CT(ASCP)