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Covid-19: an opportunity to reduce unnecessary healthcare

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2752 (Published 14 July 2020) Cite this as: BMJ 2020;370:m2752

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Rapid Response:

Covid-19: does the UK spend a large enough proportion of its national wealth on the provision of healthcare?

Dear Editor

Moynihan et al remind us that the provision of healthcare to a population costs money.(1)

Certainly, the experience of coping with the covid-19 pandemic does present an opportunity for all of us to re-examine the way we used to do things in the pre-covid era and to establish if, going forward, we should either continue to do things the same way as we used to or instead makes changes.

In the UK, when it comes to money spent on healthcare there is another factor to be taken into account.

What proportion of national wealth - represented by GDP (Gross Domestic Product) - a country chooses to spend on providing healthcare services to its population is by and large a political decision. The choices that are made will, of course, have consequences.

For example, ensuring value for money is certainly laudable and completely reasonable. However, one has to stand back and take a long hard look at things when, in a developed country, the prevailing situation is that, year on year, all the work needing to be done that presents to that country's healthcare services cannot be dealt with as a result of insufficient funding.

Furthermore, something that should never be welcomed anywhere is a state of affairs in which there are, year after year, insufficient extra funds in the system to, for example,
- enable services to patients to routinely be expanded and improved
- enable the introduction of brand new services for patients
- provide better quality buildings for those patient services to be housed in
- enable competitive salaries (viewed from a global equivalent rather than a local perspective) to be paid to healthcare staff
- undertake meaningful preventive medical work
- undertake high-quality effective public health-related surveillance work
- fund and nurture potentially important “blue skies” science and research

So what about the money? In 2017, among the G7 countries the USA spent 17.1% of GDP on healthcare, France 11.3%, Germany 11.2%, Japan 10.9%, and Canada 10.7%. During the same time period the UK spent 9.6%.(2) Such a comparison is not a terribly flattering one, and could at the very least carry with it the implication that in the UK the health of the population may not always be prioritised as highly as it is in many other nations that are otherwise outwardly similar.

When we look at the UK's recent experience with covid-19, could this possibly be telling us that, in the future, decisions by UK politicians regarding what to spend on healthcare services/research/development etc should perhaps be approached from a perspective of greater generosity? Equally, would UK taxpayers welcome levels of spending on healthcare that were at least the same as - if not better than - the proportions of GDP that are routinely being invested by the governments of other similar developed economies?

These are, of course, decisions for politicians to make.

References
(1) Moynihan R et al. Covid-19: an opportunity to reduce unnecessary healthcare? BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2752 (Published 14 July 2020).
(2) Office for National Statistics. How does UK healthcare spending compare with other countries? Gov.UK, 2019. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/....

Competing interests: No competing interests

15 July 2020
Stephen T Green
Honorary Professor of International Health
Dr Lorenzo Cladi
Sheffield Hallam University & University of Plymouth