Intended for healthcare professionals


The NHS through American eyes

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1545

Re: A different perspective

Karen Lee has been unfortunate in her experience of the NHS, I wish
her well, and hope the experience is exceptional. Here too in the US
medical care ranges from good to bad.Health statistics are no better than
in the UK, or less good.

She claims that for 350 pounds a month- their NIS payments- she and
her husband could purchase higher level care than is
available in the UK. Maybe. Insurance premiums in the US are not geared to
income, consequently over 15% of the population whose income is low cannot
afford, and has no, medical insurance. Further she might be refused, or
offered a risk related premium. The insurance would be unlikely to be
comprehensive, and carry deductibles and co-pays, or even exclusion for
her pre-existing disease. And an employer might hesitate to employ her
because a group policy is experience rated, if her condition might result
in large expenses.

In concept and structure, the NHS has nothing to learn from us, it
may well need to improve funding and standards. Its universality and
comprehesiveness, commitment to primary care, are what we need to study.

Finally she never received insurance for $50 a month, her employer
paid the balance, as a benefit.

Competing interests: No competing interests

27 December 2000
Harley Gordon
Clinical Associate Professor of Pediatrics
Health Sciences Centre at Brooklyn.