Culture Lab U.K. (Culture-Lab)

Should you be happy with health care in the U.K.?


Should you be happy with health care in the U.K.? Well yes and no. A recent study which compared five countries showed the UK as very good in some areas and failing in others…

A new study entitled "Inequities in Access to Medical Care in Five Countries" found few differences by income between the UK and Australia and many similarities when comparing it to Canada and New Zealand. The one country that stood out from the rest was the United States. The poll included 1,400 adults, ages 18 years or older, in each of the five countries.

The U.S. is unique as the one country that does not provide universal coverage for at least a core set of benefits and for its reliance on a mixed system of voluntary private insurance and public coverage for the elderly and some of the poor. The other four other nations in the survey all provide universal public coverage although they differ in the scope of benefits and cost-sharing as well as the prevalence and role played by supplemental private insurance.

Access to Care

Adults in the U.K. were the least likely to report difficulties accessing health care due to cost or medical bill problems. In the U.K. the gaps between income groups were small and few adults with either high or low income reported cost related access problems.

In contrast, the U.S. gap by income was wide on all cost related access problems and measures of financial burden. These measures included forgoing medicine or treatment, not seeking treatment when unwell and problems paying medical bills.

Cost Protection

Due to variations in public insurance policies, including the range of benefits covered by core public programs, the five countries differ substantially in the extent to which residents are exposed to out of pocket costs for medical bills. The U.S. stands out for high out-of-pocket expenses, with forty two percent of respondents estimating they paid $500 or more in the past year, compared with only five percent of adults in the U.K. Canadians were also comparatively well protected, with one third of adults reporting no out of pocket expense in the past year. Adults in Australia and New Zealand were more likely to encounter out of pocket costs than those in the U.K. or Canada even though they had a much lower level of exposure than adults in the U.S.

Quality of Care

The ratings for care received were highest in Australia and New Zealand and lowest in the U.K. and U.S. with Canadian ratings falling between these two groups.

Although adults in the U.K. reported overall low levels of medical care it emerged as the one country in which ratings of care were more positive amongst lower income adults than among adults with above-average incomes. The reverse was found in the U.S. where significant income disparities were identified on all quality and physician ratings measures. These measures included treating patients with dignity and respect, listening carefully to their health concerns and being accessible to patients by phone or in person and lower income adults in the U.S. were much less likely to give their doctors positive ratings.

Having supplemental insurance protected adults from cost related access problems in Australia, Canada, and New Zealand but only in Canada were adults with supplemental coverage more satisfied with their relations with doctors than those with public coverage only.

In the U.K. where rates of supplemental coverage are much lower across income groups, having supplemental coverage made little difference to general access, cost related barriers or quality-of-care ratings.

Health System Views

When the authors examined respondents' views of their country's medical system they discovered that the U.S. had the widest divergence of opinion between individuals with below and above-average incomes. In the U.S. differential access to health care by income may result in divided opinions about the need or direction of health care reform. However the authors noted that only a minority of the survey’s respondents in all five countries thought their system of care basically worked well and that only minor changes needed.

In the U.K. there was little difference in opinion between people with above and below average incomes even though eighteen percent of Britons surveyed thought that problems with the National Health Service meant that the system needed to be completely restructured.

The study's findings demonstrate that some health systems are more capable than others of minimizing financial barriers to access and quality care among low income adults. In addition, the results suggest that a health insurance system that fails to provide basic coverage to all residents will result in widespread inequities by income.


Australia. National coverage exists but private insurance is sometimes used to make up for some permitted patient billing by doctors.

Canada. There is national coverage but prescription drugs and dental care not covered.

New Zealand. National coverage but dental care only covers school children.

The United Kingdom. National coverage. There are however some differences between the employed and unemployed with regard to the costs of prescriptions and dental care.

The United States. Stands out amongst the industrialized nations for the pronounced health care inequalities between lower and higher income adults.