Intended for healthcare professionals

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

Money can't buy you satisfaction

BMJ 2005; 330 doi: (Published 10 March 2005) Cite this as: BMJ 2005;330:597
  1. Chris Ham, professor (
  1. 1 University of Birmingham, Birmingham B15 2RT
  1. Correspondence to:

Organisational differences between the US and UK healthcare systems mean that ideas have to be adapted through learning partnerships rather than simply copied


The NHS performs as well as or better than the US healthcare system on many objective indicators. Yet the United Kingdom shows greater interest in learning from the United States than vice versa. Is this paradox a consequence of American insularity, British credulity, or some other factor? And is there any prospect of the balance of trade in health policy ideas being reversed? If so, what aspects of health care in the United Kingdom should the United States be studying and seeking to learn from?

Comparing the two systems

Take the facts first. The United States spends almost 15% of gross domestic product on health care1 compared with less than 8% in the United Kingdom.2 Population health as measured by infant mortality and life expectancy are broadly comparable in the two countries and lag behind those achieved in high performing systems like Japan and Sweden.3 Although the majority of the public in both the United Kingdom and United States express dissatisfaction with their healthcare systems, a higher proportion of the British population think their system works well, and a lower proportion believe the system needs to be rebuilt completely, than in the United States.4

Around 45 million Americans under the age of 65 lack health insurance cover, and far more US citizens than UK citizens report that the cost of health care is a barrier to access. In a five nation survey that included Britain and the United States, Britain performed best in offering health care that was equitable, even though waiting times for treatment were the longest.5 A study of the quality of medical care in different countries found the United States performing relatively well, …

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