United Kingdom: #15 in the 2022 World Index of Health Innovation

Introduction

The United Kingdom (U.K.) ranked 15th overall in the 2022 World Index of Healthcare Innovation, down from 10th in 2021 and 13th in 2020.

The U.K. scores exceptionally high in Science & Technology (3rd) and is home to many world-class scientists and universities. British universities routinely produce Nobel laureates in Medicine or Physiology and Chemistry. Nevertheless, the U.K. ranked poorly in Fiscal Sustainability (28th) and straddled the median for Choice (9th) and Quality (21st).

Background

The United Kingdom hosts the world’s best-known model of socialized medicine (often referred to as the “Beveridge model” after its design by 20th century British socialist William Beveridge). Subsequently, health insurance is run through a single government payer, and hospitals and clinics are largely government-owned and operated. Each of the four nations of Great Britain — England, Scotland, Wales, and Northern Ireland — have their own National Health Service (NHS) which administer the local versions of the program.

Public taxes fund NHS coverage, and its services are free to patients at the point of care with no premiums, co-pays, or deductibles. Nevertheless, this unchecked form of socialized medicine often leads to price inflation and the overutilization of health care services. Thus, the NHS restricts patient choice for access to different hospitals and providers and, in turn, these restrictions and price controls lead to long wait times.

Nearly 11 percent of the English population owns private health insurance. Like many single-payer countries, private insurance allows for faster access to care — especially for elective hospital procedures. Similarly, most English hospitals are public, with a small percentage of private hospitals. Publicly owned hospitals are organized as NHS trusts and are reimbursed at nationally determined diagnosis-related group rates (i.e., “DRG rates”).

The National Institute for Health and Clinical Excellence (NICE) sets guidelines for clinically effective treatments and evaluates new technologies and pharmaceuticals based on their efficacy, cost-effectiveness, and quality. System-wide costs are contained by NHS global budgets set on a three-year cycle. These national budgets cannot be exceeded, as various branches of the federal government monitor financial performances across the country to prevent overspending. While overall health spending in the U.K. is low by European standards — at approximately 9.8 percent of its GDP — health care spending is rising rapidly and fiscal pressures are also increasing.

The U.K. is home to a sizeable innovative health care sector — led by pharmaceutical giants GlaxoSmithKline and AstraZeneca — along with numerous smaller pharmaceutical, biotech, and medical device companies. Nonetheless, the NHS establishes a pharmaceutical Price Regulation Scheme to address the costs of branded prescription drugs.

Quality

The U.K. finished 21st in Quality. This ranking marked a seven-place decrease from the year before. The U.K. placed highest at 8th in patient-centered care. The rest of the U.K.’s Quality element rankings hovered below the median, such as infrastructure (24th), pandemic preparedness and response (26th), and disease prevention (19th).

Choice

The U.K. rose four spots from the year before in the Dimension for Choice at 9th. Notably, the U.K. ranked 3rd in access to new treatments and 14th in affordability of health insurance. The U.K. struggled in freedom to choose health care services and subsequently ranked 20th. The inability to offer patient choice — a significant factor in the WIHI methodology — precluded the U.K. from finishing higher in Quality.

Science & Technology

The U.K. performed exceptionally well in Science & Technology, ranking 3rd overall. In particular, the U.K. ranked extraordinarily well in scientific discoveries at 2nd worldwide, notably due to a large number of Nobel laureates and premier research institutions. Yet, the U.K. lagged behind other developed countries in the national adoption of EHRs and health IT (accounted for in health digitization, where the U.K. ranked 13th). It also ranked below the median in the medical advances (18th).

Fiscal Sustainability

The U.K. ranked 28th in Fiscal Sustainability — the U.K.’s lowest ranking of all the WIHI dimensions. Notably, the U.K. struggled in public health care spending (26th) and growth in public health care spending (26th) due to its rising health care costs. Similarly, the U.K. ranked 22nd in national solvency, primarily due to the U.K.’s high debt-to-GDP ratio.