4.3 Funding and quality mechanisms: UK health care system 4.3.1 Background The UK has a population of about 62M. Its healthcare spend is about 9.6% GDP and it has approximately 2.6 physicians per 1000 inhabitants. The corresponding ratio is 3.6 in Germany, 2.4 in the USA and 3 in Australia. Healthcare coverage, financing and organisation Healthcare coverage is universal for citizens and residents, and largely free through the National Health Service (NHS). Private hospital care is financed through voluntary insurance or at point of use. Funding comes from general taxation and payroll tax. There are co-payments imposed on prescription drugs (outpatients only) and dentistry services. Exemptions apply to children, students, over 60s and pregnant women. Overall responsibility for health care rests with Parliament, the Secretary of State for Health and the Department of Health. Since 2012 to day responsibility has been handed to the NHS Commissioning Board. Apart from some exceptions, Clinical Commission Groups (CCGs) are responsible for NHS services at a local level. 4.3.2 Hospitals Public hospitals fall under either NHS trusts or Foundation trusts. A trust is afforded Foundation status when it demonstrates sustained high performance. Foundation trusts have greater flexibility such as more access to capital funding, and the capacity to run deficits and accumulate surpluses. A recent Commonwealth Fund report states that the UK Government plans for all trusts to become foundation trusts in the future.1 4.3.2.1 Hospital funding Trusts contract with and the NHS Commissioning Board to provide CCG’s services and are reimbursed according to nationally determined rates for diagnostic groupings (HRGs) on a casemix basis. The prices or are ‘tariffs’ based on national average costs and about 60% of hospital activity is funded in this manner. To promote efficiency, each year tariffs are reduced slightly each year.2 4.3.3 Quality Explicit policy for enhancing care quality was articulated by the government in the late 1990s, comprising monitoring, standard setting and payment by results (PbR). A quality and outcomes framework for primary care was also
4.3 Funding and quality mechanisms: UK health care system 4.3.1 Background The UK has a population of about 62M. Its healthcare spend is about 9.6% GDP and it has approximately 2.6 physicians per 1000 inhabitants. The corresponding ratio is 3.6 in Germany, 2.4 in the USA and 3 in Australia. Healthcare coverage, financing and organisation Healthcare coverage is universal for citizens and residents, and largely free through the National Health Service (NHS). Private hospital care is financed through voluntary insurance or at point of use. Funding comes from general taxation and payroll tax. There are co-payments imposed on prescription drugs (outpatients only) and dentistry services. Exemptions apply to children, students, over 60s and pregnant women. Overall responsibility for health care rests with Parliament, the Secretary of State for Health and the Department of Health. Since 2012 to day responsibility has been handed to the NHS Commissioning Board. Apart from some exceptions, Clinical Commission Groups (CCGs) are responsible for NHS services at a local level. 4.3.2 Hospitals Public hospitals fall under either NHS trusts or Foundation trusts. A trust is afforded Foundation status when it demonstrates sustained high performance. Foundation trusts have greater flexibility such as more access to capital funding, and the capacity to run deficits and accumulate surpluses. A recent Commonwealth Fund report states that the UK Government plans for all trusts to become foundation trusts in the future.1 4.3.2.1 Hospital funding Trusts contract with CCG’s and the NHS Commissioning Board to provide services and are reimbursed according to nationally determined rates for diagnostic groupings (HRGs) on a casemix basis. The prices or ‘tariffs’ are based on national average costs and about 60% of hospital activity is funded in this manner. To promote efficiency, each year tariffs are reduced slightly each year.2 4.3.3 Quality Explicit policy for enhancing care quality was articulated by the government in the late 1990s, comprising monitoring, standard setting and payment by results (PbR). A quality and outcomes framework for primary care was also