Intended for healthcare professionals


UK healthcare system is one of most efficient in rich countries

BMJ 2011; 343 doi: (Published 09 August 2011) Cite this as: BMJ 2011;343:d5143
  1. Anne Gulland
  1. 1London

The United Kingdom has the second most efficient health system of 19 economically developed countries, while the US health system ranks 17th, a comparative study has found.

The research in the Journal of the Royal Society of Medicine (doi:10.1258/shorts.2011.011076) assessed the cost effectiveness of the health systems in 19 countries from 1980 to 2005. It found that Ireland’s system was the most cost effective, followed by the United Kingdom in second place, then New Zealand, Austria, and Australia.

The authors used a “simple economic model” to determine cost effectiveness. A nation’s proportion of gross domestic product spent on health was compared with how much death rates had decreased among adults between 1980 and 2005. The authors used economic figures from the US Bureau of Statistics and mortality figures from the World Health Organization.

By the end of the period spending on health had risen in every country except Ireland, with the highest average total being in the US, Germany, and Switzerland. The UK’s spend was 15th out of the 19 countries studied.

However, although the UK’s spending on health was lower than that of many other countries, the authors warned against complacency, as the UK had the fifth highest mortality among adults aged 55 to 74 years and the sixth highest among younger adults.

One of the study’s authors, Colin Pritchard, research professor in psychiatric social work at Bournemouth University, said, “Our NHS is wonderful. The only thing wrong with it is that it’s been relatively underfunded . . . When the present government are talking about competition and choice and the idea that private healthcare might have something really fundamental to offer, all you have to do is compare America, the land of choice and competition, and their results are dismal.”

Professor Pritchard said that although market forces are often assumed to lead to greater efficiency, the nature of the US system, with much funding from private insurance, was “innately inefficient,” because insurance companies had to make a profit.

The authors said that the findings were a cause of celebration, as all countries had seen falls in their death rates, with more than 170 000 people in the UK and 500 000 in the US alive today who “would not have been 25 years ago.” Their results show that the UK’s mortality rate among people aged 15 to 74 has fallen 43% since 1980.

“It is hoped these results might be a boost to patients and their families in every Western country, but especially those using the NHS, and that some recognition goes to UK frontline staff, who over the past 25 years have achieved more with relatively less,” the authors write.


Cite this as: BMJ 2011;343:d5143

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