1. Majeed, Azeem MD, MRCGP, FFPHM


Abstract: This United Kingdom has had universal health coverage since 1948, provided through its government-funded National Health Service (NHS). In recent years, increasing workload and treatment costs have put a considerable strain on the NHS. The government has responded to these challenges through a controversial program of organizational changes in the NHS. In its most recent policy initiatives, the government proposes to increase the proportion of national income spent on the NHS and make much greater use of private-sector health care providers.


THE UNITED KINGDOM HAS had a system of universal health coverage since the creation of its National Health Service (NHS) in 1948 (Timmins, 2001). With the formation of the NHS, the government of the United Kingdom became responsible for funding access to health care and for supplying health services to its population. All residents of the United Kingdom were given the right to register with a general practitioner, who is responsible for both providing primary care services and organizing referrals for specialist care (Majeed, 1999).


The approach taken to providing universal health care in the United Kingdom was different to that in other developed countries. Although most developed countries have implemented universal health coverage (with the notable exception of the United States), few countries have chosen to follow the United Kingdom's model of creating a single government controlled organization to both fund and supply health services to their populations.


Most of the medical services provided by the NHS remain free at the point of use, more than fifty years after its creation (NHS, 2003). This includes consultations with doctors (both general practitioners and hospital specialists) and other health professionals, emergency treatment in accident and emergency departments, elective and urgent operations, breast and cervical cancer screening services for women, and immunizations that are part of national programs (such as those for children and people at risk of influenza). There is a charge for prescriptions issued by general practitioners that is payable by some patients (currently about $10.30 per prescription item). However, because most prescriptions are issued to groups that are exempt from these charges (such as children, people over 60 years of age, and people with low incomes or with specified chronic diseases), 85% of all drugs issued by the NHS are prescribed at no cost to the patient (Department of Health, 2002a).


The implementation of universal health coverage and creation of the NHS, although notable achievements in the fields of health and social policy, have not left the United Kingdom immune to the challenges facing health care systems across the developed world. Like many other countries, the United Kingdom has grappled with the problem of maintaining the population's access to a comprehensive range of high-quality health services while at the same time trying to limit the central government's spending on health. Moreover, while universal coverage and health care free at the point of use allow all groups in the population to access health services, socioeconomic disparities remain, both in health status and the use of health services (Acheson, 1998). Hence, reducing health disparities remains a key priority for the government of the United Kingdom (Department of Health, 2002b).


The single-payer nature of the United Kingdom's health service means that the NHS collects a substantial amount of data on the population's use of health services. In this article, I describe some of these recent trends, what they mean for universal coverage and the provision of health services, and how the government of the United Kingdom is responding to the challenges facing its health care system. Because the United Kingdom is actually a confederation of four countries (England, Wales, Scotland, and Northern Ireland), each individual country has its own NHS. I have concentrated on data for England, the largest of the countries in the United Kingdom.