Intended for healthcare professionals

Education And Debate US and UK health care: a special relationship?

What can the UK and US health systems learn from each other?

BMJ 2005; 330 doi: (Published 03 March 2005) Cite this as: BMJ 2005;330:530
  1. Lois Quam, chief executive officer1,
  2. Richard Smith, chief executive (
  1. 1 Ovations, PO Box 1459, Minneapolis MN 55440, USA
  2. 2 UnitedHealth Europe, London SW1P 1SB
  1. Correspondence to: R Smith

    The NHS and US insurance based health systems seem worlds apart. Despite the differences, each has much to learn from examples of good practice in the other


    Learning within clinical medicine often spreads rapidly across the globe. Once an innovation—for example, thrombolysis for patients with heart attacks—is accepted, it is likely to be picked up rapidly in most countries. This is because cardiologists travel to world meetings, know each other well, read the same international journals, and are encouraged to innovate by global pharmaceutical companies. In stark contrast, innovations in how care is organised and delivered have rarely spread. We examine why countries have not been good at learning from each other and some of the areas where learning between the United Kingdom and United States could be beneficial.

    Barriers to learning

    One obvious barrier is that healthcare systems are culturally, politically, economically, and socially bound in a way that cardiological interventions are not. This has led some people to believe that international learning is impossible. Another barrier is mutual ignorance. Health systems have become so complex that few people have a deep understanding of more than one system. Who in Britain, for example, could explain with complete confidence the workings of the NHS in England, Scotland, Wales, and Northern Ireland? This inhibits learning not only internationally but also within one nation state.

    A more disturbing block to learning is a feeling that to learn from others is a sign of weakness—even failure. We saw some of this perhaps in the hostile reaction to the BMJ paper that suggested that Kaiser Permante might get significantly better outputs than the NHS for roughly similar inputs.1 There were legitimate reasons for criticising the study,2 3 but a much healthier reaction to the paper would have been to look more deeply at Kaiser and …

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