Analysis

How the NHS measures up to other health systems

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1079 (Published 22 February 2012) Cite this as: BMJ 2012;344:e1079
  1. David Ingleby, professor1,
  2. Martin McKee, professor23,
  3. Philipa Mladovsky, research fellow24,
  4. Bernd Rechel, researcher23
  1. 1Faculty of Social and Behavioural Sciences, Utrecht University, Netherlands
  2. 2European Observatory on Health Systems and Policies, London, UK
  3. 3London School of Hygiene and Tropical Medicine, London, UK
  4. 4LSE Health, London School of Economics and Political Science, London
  1. Correspondence to: M McKee Martin.McKee{at}lshtm.ac.uk
  • Accepted 4 February 2012

Debate about how to improve the NHS has been handicapped by a lack of suitable comparative data about the functioning of other health systems. David Ingleby and colleagues examine two recent reports by the Commonwealth Fund

The government’s plans for reorganising the English National Health Service have sparked heated discussions about the performance of the UK health system in comparison with that of other countries. Politicians favouring reform have emphasised real and perceived shortcomings of the NHS, while opponents have lauded its successes. Objective data have been sadly lacking in much of this debate. Arbitrary examples of good or bad performance from the UK and various other countries have been thrown back and forth, often using totally incommensurable data. Two new publications from the Commonwealth Fund, a New York based health policy institute, shed some much needed light on these questions.1 2 We analyse the data and discuss the strengths and weaknesses of the NHS in the light of current proposals for reform.

The studies

The first study applied uniform criteria to assess health systems in 14 high income countries (Australia, Canada, Denmark, France, Italy, Japan, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the United States). Most of the data came from telephone interviews carried out in 2010 with over 19 000 randomly chosen adults from 11 countries (1511 in the UK).3 4 Samples were weighted to ensure that they were representative of the general population; to minimise possible response biases, questions were as detailed and factual as possible. These data were supplemented by information published by the Organisation for Economic Cooperation and Development5 and from a recent study on mortality amenable to healthcare.6

The second publication was based on telephone interviews conducted in 2011 in the same 11 countries as in the first study …

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