Department of Health Policy, London School of Economics and Political Science, London, UK
Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA.
BMJ. 2019 Nov 27;367:l6326. doi: 10.1136/bmj.l6326.
To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care.
Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development.
Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US.
79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health.
The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections.
The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.
鉴于英国国家医疗服务体系（NHS）面临持续的财政压力、不断增加的需求水平以及社会保健支出削减，本研究旨在评估其相对于其他高收入国家医疗体系的表现。
使用来自 Eurostat 和经济合作与发展组织等主要国际组织的二次数据进行观察性研究。
英国和九个高收入国家医疗体系：澳大利亚、加拿大、丹麦、法国、德国、荷兰、瑞典、瑞士和美国。
七个领域的 79 项指标：人口和医疗保健覆盖、医疗保健和社会支出、结构能力、利用、获得医疗保健的机会、医疗保健质量和人口健康。
2017 年，英国的人均医疗保健支出在所有研究国家中最低（英国 3825 英镑（2972 欧元；3392 美元）；平均 5700 美元），支出增长水平略低（过去四年国内生产总值增长 0.02%，而平均水平为 0.07%）。尽管利用率（住院人数）处于平均水平，但英国的未满足需求率最低，医生和护士的人均数量也最低。英国的预期寿命略低于平均水平（81.3 岁，平均为 81.7 岁），乳腺癌、宫颈癌、结肠癌和直肠癌的存活率也较低。尽管一些医疗服务结果较差，如腹部手术后的术后败血症（英国每 10 万出院者 2454 例；平均每 10 万出院者 2058 例）、急性心肌梗死 30 天死亡率（英国 7.1%；平均 5.5%）和缺血性中风（英国 9.6%；平均 6.6%），但英国关节手术后深静脉血栓形成和医疗保健相关感染的发生率较低。
NHS 表现出一些良好的表现，包括医疗服务结果，但支出、患者安全和人口健康状况均处于中下水平。总的来说，这些结果表明，如果 NHS 希望在人口增长的压力下实现可比的健康结果，它可能需要增加支出，以增加劳动力和长期护理的供应，并减少社会支出的下降趋势，以达到可比国家的水平。
