A UK Perspective on the 2013 Commonwealth Fund International Survey Peter C. Smith Emeritus Professor of Health Policy, Imperial College Business School Honorary Professor of Health Economics, University of York peter.smith@imperial.ac.uk

Key findings for the UK Popular support for the UK health system remains very strong (1st out of 11) Cost-related barriers to access remain very low (1st out of 11) Physical access (waiting times, out-of-hours, e-mail) consistently better than the median ... while spending is low (10th out of 11)

Context since 2010 Severe squeeze on publicly funded health expenditure after years of substantial growth Major administrative reorganization of local strategic purchasing and other regulatory arrangements in England A high-profile scandal (mid-Staffordshire hospital) exposing serious weaknesses in compassion and quality of care Efforts to diversify the market in providers of healthcare in England.

Percentage responding: “On the whole, the system works pretty well and only minor changes are necessary to make it work better”, 2001-2013 Source: Commonwealth Fund International Health Policy Surveys, 2001-2013

Health Expenditure per capita, $US constant prices Source: OECD Health Data 2013

In this light, the results of the 2013 Survey are reassuring Popular support for the National Health Service remains high. Waiting times for most aspects of care remain at historically low levels. Out-of-hours access remains relatively good. Protection from the personal costs of healthcare, and from insurance bureaucracy, remains exceptionally strong. While expenditure remains low relative to the other countries surveyed.

Quality Watch Initiative by the Nuffield Trust and Health Foundation to undertake an independent audit of quality trends in England in the light of expenditure squeeze. Generally positive findings, though some concerns relating to unnecessary hospital admissions and resource pressures in emergency care. http://www.qualitywatch.org.uk/

There are nevertheless serious areas of concern for the future It is very hard to see how the current benefits package can be sustained in the medium term, given the very challenging limitations on funding currently budgeted for the NHS The scope for productivity gains is limited, at least in the short term. Without further tax contributions, possible responses include: reduced scope of treatments covered; introduction of cost sharing; increased waiting times; or other quality reductions Any of these outcomes may have serious consequences for NHS performance and popular support. The Commonwealth Fund Surveys will be invaluable references for tracking future trends.