Tag Archives: Healthcare

NHS holds on to top spot in healthcare survey

The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health thinktank.

It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-rated health system.

The NHS has held on to the top spot despite the longest budget squeeze in its 69-year history, serious understaffing and the disruption caused by a radical restructuring of the service in England in 2013.

Its ranking is even more notable because the thinktank found the UK to put the fourth smallest amount of GDP into healthcare among the 11 countries. While the US spends 16.6% of its national income on health, the UK comes near the bottom, investing just 9.9%. Only New Zealand (9.4%), Norway (9.3%) and Australia (9%) put in less.

The UK emerged with the best healthcare system overall, just ahead of Australia, with the Netherlands a little further behind. A group of experts assessed them against 11 criteria designed to measure the effectiveness of different health systems.

“The UK stands out as a top performer in most categories except for healthcare outcomes, where it ranks with the US near the bottom,” according to the Mirror, Mirror 2017 report from the US-based Commonwealth Fund.

“In contrast to the US, over the last decade the UK saw a larger decline in mortality amenable to healthcare than the other countries studied,” the report says. Experts view that as a key measure, because it captures how well a health system is doing at preventing, detecting and treating illness.

Jeremy Hunt, the UK’s health secretary, lauded the NHS’s top ranking. “These outstanding results are a testament to the dedication of NHS staff who, despite pressure on the frontline are delivering safer, more compassionate care than ever,” he said.

“Ranked the best healthcare system of 11 wealthy countries, the NHS has again showed why it is the single thing that makes us most proud to be British.”

Supporters of the NHS are likely to use the Commonwealth Fund’s findings to rebut claims that the NHS is wasteful and inefficient. Theresa May has told the chief executive of NHS England, Simon Stevens, to ensure that the service uses its £120bn annual budget more efficiently.

The US was again judged to be the worst system, despite investing far more money than the other countries. It spends 5.2 percentage points more of its GDP on health than France, which invests the second largest amount (11.4%).

The UK came first in four of the 11 categories. It was judged to deliver the safest care, be the best at “care processes”, provide the most affordable care and offer the most equity.

However, the gap between the UK and the next best-placed countries is narrowing. Those four categories are only half of the eight in which the UK came top in 2014, when the fund last undertook its in-depth multi-country research. The UK also came second for providing preventative and well-coordinated care.

But the NHS came 10th on healthcare outcomes, a category that measures how successful treatment has been – a significant weakness that was also identified in 2014. The experts concluded that the UK does very poorly in relative terms on five-year survival rates for breast and bowel cancer, and deaths among people admitted to hospital after a stroke, for example.

An NHS England spokesperson said: “This international research is a welcome reminder of the fundamental strengths of the NHS, and a call to arms in support of the NHS Forward View practical plan to improve cancer, mental health and other outcomes of care.”

Richard Murray, the director of policy at the London-based King’s Fund thinktank, said: “The UK’s ranking is welcome and reflects the strong fundamentals of the NHS. Universal access to health services, a founding principle of the NHS, is rightly recognised by the Commonwealth Fund ranking.

“Other international comparisons that are largely based on measuring the health of the population of the country do not always rank the UK as highly. The Commonwealth Fund also recognises these poorer health outcomes, and this is particularly stark given the cuts to public health spending that were announced recently.”

The rankings

  1. UK
  2. Australia
  3. Netherlands
  4. Norway
  5. New Zealand
  6. Sweden
  7. Switzerland
  8. Germany
  9. Canada
  10. France
  11. United States

Source: Mirror, Mirror 2017 report by the Commonwealth Fund

NHS holds on to top spot in healthcare survey

The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health thinktank.

It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-rated health system.

The NHS has held on to the top spot despite the longest budget squeeze in its 69-year history, serious understaffing and the disruption caused by a radical restructuring of the service in England in 2013.

Its ranking is even more notable because the thinktank found the UK to put the fourth smallest amount of GDP into healthcare among the 11 countries. While the US spends 16.6% of its national income on health, the UK comes near the bottom, investing just 9.9%. Only New Zealand (9.4%), Norway (9.3%) and Australia (9%) put in less.

The UK emerged with the best healthcare system overall, just ahead of Australia, with the Netherlands a little further behind. A group of experts assessed them against 11 criteria designed to measure the effectiveness of different health systems.

“The UK stands out as a top performer in most categories except for healthcare outcomes, where it ranks with the US near the bottom,” according to the Mirror, Mirror 2017 report from the US-based Commonwealth Fund.

“In contrast to the US, over the last decade the UK saw a larger decline in mortality amenable to healthcare than the other countries studied,” the report says. Experts view that as a key measure, because it captures how well a health system is doing at preventing, detecting and treating illness.

Jeremy Hunt, the UK’s health secretary, lauded the NHS’s top ranking. “These outstanding results are a testament to the dedication of NHS staff who, despite pressure on the frontline are delivering safer, more compassionate care than ever,” he said.

“Ranked the best healthcare system of 11 wealthy countries, the NHS has again showed why it is the single thing that makes us most proud to be British.”

Supporters of the NHS are likely to use the Commonwealth Fund’s findings to rebut claims that the NHS is wasteful and inefficient. Theresa May has told the chief executive of NHS England, Simon Stevens, to ensure that the service uses its £120bn annual budget more efficiently.

The US was again judged to be the worst system, despite investing far more money than the other countries. It spends 5.2 percentage points more of its GDP on health than France, which invests the second largest amount (11.4%).

The UK came first in four of the 11 categories. It was judged to deliver the safest care, be the best at “care processes”, provide the most affordable care and offer the most equity.

However, the gap between the UK and the next best-placed countries is narrowing. Those four categories are only half of the eight in which the UK came top in 2014, when the fund last undertook its in-depth multi-country research. The UK also came second for providing preventative and well-coordinated care.

But the NHS came 10th on healthcare outcomes, a category that measures how successful treatment has been – a significant weakness that was also identified in 2014. The experts concluded that the UK does very poorly in relative terms on five-year survival rates for breast and bowel cancer, and deaths among people admitted to hospital after a stroke, for example.

An NHS England spokesperson said: “This international research is a welcome reminder of the fundamental strengths of the NHS, and a call to arms in support of the NHS Forward View practical plan to improve cancer, mental health and other outcomes of care.”

Richard Murray, the director of policy at the London-based King’s Fund thinktank, said: “The UK’s ranking is welcome and reflects the strong fundamentals of the NHS. Universal access to health services, a founding principle of the NHS, is rightly recognised by the Commonwealth Fund ranking.

“Other international comparisons that are largely based on measuring the health of the population of the country do not always rank the UK as highly. The Commonwealth Fund also recognises these poorer health outcomes, and this is particularly stark given the cuts to public health spending that were announced recently.”

The rankings

  1. UK
  2. Australia
  3. Netherlands
  4. Norway
  5. New Zealand
  6. Sweden
  7. Switzerland
  8. Germany
  9. Canada
  10. France
  11. United States

Source: Mirror, Mirror 2017 report by the Commonwealth Fund

NHS holds on to top spot in healthcare survey

The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health thinktank.

It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-rated health system.

The NHS has held on to the top spot despite the longest budget squeeze in its 69-year history, serious understaffing and the disruption caused by a radical restructuring of the service in England in 2013.

Its ranking is even more notable because the thinktank found the UK to put the fourth smallest amount of GDP into healthcare among the 11 countries. While the US spends 16.6% of its national income on health, the UK comes near the bottom, investing just 9.9%. Only New Zealand (9.4%), Norway (9.3%) and Australia (9%) put in less.

The UK emerged with the best healthcare system overall, just ahead of Australia, with the Netherlands a little further behind. A group of experts assessed them against 11 criteria designed to measure the effectiveness of different health systems.

“The UK stands out as a top performer in most categories except for healthcare outcomes, where it ranks with the US near the bottom,” according to the Mirror, Mirror 2017 report from the US-based Commonwealth Fund.

“In contrast to the US, over the last decade the UK saw a larger decline in mortality amenable to healthcare than the other countries studied,” the report says. Experts view that as a key measure, because it captures how well a health system is doing at preventing, detecting and treating illness.

Jeremy Hunt, the UK’s health secretary, lauded the NHS’s top ranking. “These outstanding results are a testament to the dedication of NHS staff who, despite pressure on the frontline are delivering safer, more compassionate care than ever,” he said.

“Ranked the best healthcare system of 11 wealthy countries, the NHS has again showed why it is the single thing that makes us most proud to be British.”

Supporters of the NHS are likely to use the Commonwealth Fund’s findings to rebut claims that the NHS is wasteful and inefficient. Theresa May has told the chief executive of NHS England, Simon Stevens, to ensure that the service uses its £120bn annual budget more efficiently.

The US was again judged to be the worst system, despite investing far more money than the other countries. It spends 5.2 percentage points more of its GDP on health than France, which invests the second largest amount (11.4%).

The UK came first in four of the 11 categories. It was judged to deliver the safest care, be the best at “care processes”, provide the most affordable care and offer the most equity.

However, the gap between the UK and the next best-placed countries is narrowing. Those four categories are only half of the eight in which the UK came top in 2014, when the fund last undertook its in-depth multi-country research. The UK also came second for providing preventative and well-coordinated care.

But the NHS came 10th on healthcare outcomes, a category that measures how successful treatment has been – a significant weakness that was also identified in 2014. The experts concluded that the UK does very poorly in relative terms on five-year survival rates for breast and bowel cancer, and deaths among people admitted to hospital after a stroke, for example.

An NHS England spokesperson said: “This international research is a welcome reminder of the fundamental strengths of the NHS, and a call to arms in support of the NHS Forward View practical plan to improve cancer, mental health and other outcomes of care.”

Richard Murray, the director of policy at the London-based King’s Fund thinktank, said: “The UK’s ranking is welcome and reflects the strong fundamentals of the NHS. Universal access to health services, a founding principle of the NHS, is rightly recognised by the Commonwealth Fund ranking.

“Other international comparisons that are largely based on measuring the health of the population of the country do not always rank the UK as highly. The Commonwealth Fund also recognises these poorer health outcomes, and this is particularly stark given the cuts to public health spending that were announced recently.”

The rankings

  1. UK
  2. Australia
  3. Netherlands
  4. Norway
  5. New Zealand
  6. Sweden
  7. Switzerland
  8. Germany
  9. Canada
  10. France
  11. United States

What is the role of patients in healthcare? Live discussion

The role of the patient is changing. Gone are the days when they were a passive recipient of care. Doctors are now expected to engage patients in their own health, care and treatment. There are also a number of initiatives to foster patient involvement in the design, planning and delivery of health services.

With advances in technology, there is scope for patients to have more control over their care. A raft of apps and digital innovations can help keep patients with long-term conditions at home longer. Patients now manage their own health with the support of doctors.

In a column for the Healthcare Professionals Network, commentator Richard Vize wrote: “The ubiquitous availability of medical information is irrevocably putting more power in the hands of patients.”

He added that in the UK, access to information is growing in a random and patchy way, while the ability of patients to use that information effectively in their discussions with doctors and other clinicians is entirely at the whim of the professional who is seeing them.

How can this be changed? What is the role of technology in empowering patients and healthcare professionals? What examples are there of patients being involved in designing and delivering health services? How can patient feedback play a part? Join our expert panel on Thursday 20 July from 12.30pm to 2pm to answer these questions and more.

The live chat is not video or audio-enabled but will take place in the comments section (below). If you would like to feature on the panel or propose questions, please get in touch via sarah.johnson@theguardian.com or @GdnHealthcare (#Gdnpatients) on Twitter.

Discussion commissioned and controlled by the Guardian, funded by Brother

The panel so far

Michael Seres, blogger and devises social media strategies around patient engagement. He was diagnosed aged 12 with the incurable bowel condition Crohn’s disease

Angela Coulter, senior researcher at the department of public health, University of Oxford

Sophie Castle-Clarke, fellow in health policy, Nuffield Trust

James Munro, chief executive, Care Opinion

What is the role of patients in healthcare? Live discussion

The role of the patient is changing. Gone are the days when they were a passive recipient of care. Doctors are now expected to engage patients in their own health, care and treatment. There are also a number of initiatives to foster patient involvement in the design, planning and delivery of health services.

With advances in technology, there is scope for patients to have more control over their care. A raft of apps and digital innovations can help keep patients with long-term conditions at home longer. Patients now manage their own health with the support of doctors.

In a column for the Healthcare Professionals Network, commentator Richard Vize wrote: “The ubiquitous availability of medical information is irrevocably putting more power in the hands of patients.”

He added that in the UK, access to information is growing in a random and patchy way, while the ability of patients to use that information effectively in their discussions with doctors and other clinicians is entirely at the whim of the professional who is seeing them.

How can this be changed? What is the role of technology in empowering patients and healthcare professionals? What examples are there of patients being involved in designing and delivering health services? How can patient feedback play a part? Join our expert panel on Thursday 20 July from 12.30pm to 2pm to answer these questions and more.

The live chat is not video or audio-enabled but will take place in the comments section (below). If you would like to feature on the panel or propose questions, please get in touch via sarah.johnson@theguardian.com or @GdnHealthcare (#Gdnpatients) on Twitter.

Discussion commissioned and controlled by the Guardian, funded by Brother

The panel so far

Michael Seres, blogger and devises social media strategies around patient engagement. He was diagnosed aged 12 with the incurable bowel condition Crohn’s disease

Angela Coulter, senior researcher at the department of public health, University of Oxford

Sophie Castle-Clarke, fellow in health policy, Nuffield Trust

James Munro, chief executive, Care Opinion

NHS holds on to top spot in healthcare survey

The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health thinktank.

It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-rated health system.

The NHS has held on to the top spot despite the longest budget squeeze in its 69-year history, serious understaffing and the disruption caused by a radical restructuring of the service in England in 2013.

Its ranking is even more notable because the thinktank found the UK to put the fourth smallest amount of GDP into healthcare among the 11 nations. While the US spends 16.6% of its national income on health, the UK comes near the bottom, investing just 9.9%. Only New Zealand (9.4%), Norway (9.3%) and Australia (9%) put in less.

The UK emerged with the best healthcare system overall, just ahead of Australia, with the Netherlands a little further behind. A group of experts assessed them against 11 criteria designed to measure the effectiveness of different health systems.

“The UK stands out as a top performer in most categories except for healthcare outcomes, where it ranks with the US near the bottom,” according to the Mirror, Mirror 2017 report from the US-based Commonwealth Fund.

“In contrast to the US, over the last decade the UK saw a larger decline in mortality amenable to healthcare than the other countries studied,” the report says. Experts view that as a key measure, because it captures how well a health system is doing at preventing, detecting and treating illness.

Jeremy Hunt, the UK’s health secretary, lauded the NHS’s top ranking. “These outstanding results are a testament to the dedication of NHS staff, who despite pressure on the frontline are delivering safer, more compassionate care than ever,” he said.

“Ranked the best healthcare system of 11 wealthy countries, the NHS has again showed why it is the single thing that makes us most proud to be British.”

Supporters of the NHS are likely to use the Commonwealth Fund’s findings to rebut claims that the NHS is wasteful and inefficient. Theresa May has told the chief executive of NHS England, Simon Stevens, to ensure that the service uses its £120bn annual budget more efficiently.

The US was again judged to be the worst system, despite investing far more money than all the other countries. It spends 5.2 percentage points more of its GDP on health than France, which invests the second largest amount (11.4%).

The UK came first in four of the 11 categories. It was judged to deliver the safest care, be the best at “care processes”, provide the most affordable care and offer the most equity.

However, the gap between the UK and the next best-placed countries is narrowing. Those four categories are only half of the eight in which the UK came top in 2014, when the fund last undertook its in-depth multi-country research. The UK also came second for providing preventative and well-coordinated care.

But the NHS came 10th on healthcare outcomes, a category that measures how successful treatment has been – a significant weakness that was also identified in 2014. The experts concluded that the UK does very poorly in relative terms on five-year survival rates for breast and bowel cancer, and deaths among people admitted to hospital after a stroke, for example.

An NHS England spokesperson said: “This international research is a welcome reminder of the fundamental strengths of the NHS, and a call to arms in support of the NHS Forward View practical plan to improve cancer, mental health and other outcomes of care.”

Richard Murray, the director of policy at the London-based King’s Fund thinktank, said: “The UK’s ranking is welcome and reflects the strong fundamentals of the NHS. Universal access to health services, a founding principle of the NHS, is rightly recognised by the Commonwealth Fund ranking.

“Other international comparisons that are largely based on measuring the health of the population of the country do not always rank the UK as highly. The Commonwealth Fund also recognises these poorer health outcomes, and this is particularly stark given the cuts to public health spending that were announced recently.”

How to make global universal healthcare a reality


1 | Accept there’s no such thing as a ‘perfect healthcare model’

All healthcare models have their challenges in terms of systems capacity, fiscal space and good governance. I think the progress of countries like Thailand and Sri Lanka towards universal health is certainly laudable, but they each have different approaches to getting there. Thailand’s journey began incrementally and over the years through consistent investment in Primary Health Care (PHC). Meanwhile, India is more focused on achieving Universal Health Care (UHC) through mixed health markets featuring both public and private sector players. Priya Balasubramaniam, senior public health scientist and director, PHFI-RNE Universal Health Initiative, Public Health Foundation of India, New Delhi, India

2 | Have the same healthcare provider for the rich and the poor

If we have dual systems with the “national service” caring for the poor and the private sector caring for the rich, quality will be an afterthought. We need the rich and poor to be cared for by the same provider – this ensures that high quality will be a political priority as those with voting influence are directly affected by the quality of services provided. Jolene Skordis, director, UCL Centre for Global Health Economics, London, UK @JSkordis

3 | Give public-private partnerships serious consideration

The PPP model needs to be taken to scale in PHC in order to achieve UHC in a planned time frame. I have worked in many parts of the developing world and in general governments have not been able to step up. Now is the time to test new models as the old system is not working. We need a blended service delivery mechanism. We have to open up the insurance space and governments must push for universal insurance cover for all citizens. This is what we’re trying to do in Kenya. Siddharth Chatterjee, resident coordinator to Kenya, United Nations, Nairobi, Kenya @sidchat1 @UNDPKenya

4 | Learn from the places getting it right

Ghana’s health system isn’t the best I’ve seen but they’ve got some very fundamental things right and have been continually improving over many years. Some of the fundamentals are a commitment to all Ghanaians getting quality, affordable healthcare, and trying to create a national-level risk pool – so the healthier and wealthier subsidise the sicker and poorer. From small-scale experimentation with community-based health insurance, they scaled up to national health insurance, and are now working through the tough challenges of purchasing health services more strategically and sustainably for everyone. The private sector plays a significant role in Ghana’s healthcare provision – a recent World Bank study of Ghana’s private sector noted that Ghanaians access care from private sources more than half of the time. Cicely Thomas, senior programme officer, Results for Development, Washington DC, US @results4dev @cicelysimone

5 | Raise taxes to reach the poorest

In the majority of developed countries, health services are mostly private. But they are publicly regulated and financed. What we have learned over time is that an equitable system always relies on cross-subsidy, from rich to poor and from healthy to sick. Progressive taxation and public subsidy to ensure access to services is the essence if we want to reach universality of access to health services. Agnes Soucat, director, health financing and governance, World Health Organisation, Geneva, Switzerland @asoucat @WHO

6 | Don’t focus on arbitrary targets for health spending

The Abuja declaration expects African governments to spend 15% of GDP on healthcare. That’s not easy to do – and is not essential. Singapore spends about 5% of GDP on healthcare and has done a fantastic job in ensuring every citizen has access to a good quality service. Sri Lanka spends between 3%–5% and India is pushing for 2.5%. But the question should be about what can you do best with what you can afford to spend. There is no magic GDP number that will deliver UHC since every country has varied resources. Ultimately it is not only about more money, but also how you end up spending your existing health budget that matters. Resources are often misspent in the health sector with an inordinate focus towards hospital care. Siddharth Chatterjee and Priya Balasubramaniam

7 | Invest more in preventing people getting sick

Health is not just the remit of health ministries – sanitation, housing, welfare and education are just a few of the bedrocks of improving population health. We shouldn’t think of healthcare as a pill or a hospital or programme to treat a single disease. Healthcare is clean water and a diet that does not place you at risk of diabetes or stunting. Healthcare is the education you need to find work and pay for a safe and warm home for your family. Healthcare is delaying early marriage and early pregnancy for vulnerable girls. Prevention has been relatively neglected in our policy priorities. Perhaps because prevention activities can seldom be charged for and people are not yet sick so it can be hard to convince both the public and policymakers of the benefits of preventative measures, even though prevention is usually the most cost-effective way to address disease. Jolene Skordis

8 | Make tackling individual diseases have a wider impact

In resource-limited settings, what health initiatives can catalyse overall healthcare systems strengthening? Vertical initiatives anchored to one disease, such as the focus on HIV through PEPFAR and Global Fund, have led to broader health-system strengthening by alleviating the HIV burden as well as increasing outcomes in mother-to-child transmission. Anand Reddi, corporate and medical affairs, Gilead Sciences Inc, San Francisco, US @ReddiAnand @GileadSciences

9 | Focus on equity, not just the number of people reached

If we look back at the millennium development goals it is clear that the focus on reaching big numbers has had a detrimental effect on equity. Too often, national policies do not specifically address how marginalised groups will be reached by development programmes in order to benefit from the new facilities and services provided. This problem is often made worse in low-income areas where the services are offered on a cost recovery basis. Helen Hamilton, policy adviser for health, Sightsavers, Haywards Heath, UK @HelenCHamilton @Sightsavers_Pol

10 | Be honest about how money shapes healthcare decisions

India’s case (and that of South Africa, Brazil and the US) proves how users of a health services are often not the best judge of health services. We rely on doctors to tell us what care we need. If doctors can profit from giving us incorrect advice, they may well do so – particularly if there is little harm likely to be done (eg sending paying patients for extra, unneeded tests or procedures). This results in the cost of care increasing rapidly in the private sector, to the point where even the middle classes can’t afford health insurance in South Africa and the US. We need to remove the profit motive from healthcare if we want efficiency and effectiveness. Jolene Skordis

11 | Accept that political will trumps everything

If we want to bridge the gap between current healthcare provision and achieving UHC globally, we must not forget the importance of the political climate and landscape in countries. Many countries (including the US) have come up with innovative ways to work towards UHC, and have qualified professionals to manage their health systems. However, without the political will to do so, they continue to struggle. Cicely Thomas

Read the full Q&A here.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

How to make global universal healthcare a reality


1 | Accept there’s no such thing as a ‘perfect healthcare model’

All healthcare models have their challenges in terms of systems capacity, fiscal space and good governance. I think the progress of countries like Thailand and Sri Lanka towards universal health is certainly laudable, but they each have different approaches to getting there. Thailand’s journey began incrementally and over the years through consistent investment in Primary Health Care (PHC). Meanwhile, India is more focused on achieving Universal Health Care (UHC) through mixed health markets featuring both public and private sector players. Priya Balasubramaniam, senior public health scientist and director, PHFI-RNE Universal Health Initiative, Public Health Foundation of India, New Delhi, India

2 | Have the same healthcare provider for the rich and the poor

If we have dual systems with the “national service” caring for the poor and the private sector caring for the rich, quality will be an afterthought. We need the rich and poor to be cared for by the same provider – this ensures that high quality will be a political priority as those with voting influence are directly affected by the quality of services provided. Jolene Skordis, director, UCL Centre for Global Health Economics, London, UK @JSkordis

3 | Give public-private partnerships serious consideration

The PPP model needs to be taken to scale in PHC in order to achieve UHC in a planned time frame. I have worked in many parts of the developing world and in general governments have not been able to step up. Now is the time to test new models as the old system is not working. We need a blended service delivery mechanism. We have to open up the insurance space and governments must push for universal insurance cover for all citizens. This is what we’re trying to do in Kenya. Siddharth Chatterjee, resident coordinator to Kenya, United Nations, Nairobi, Kenya @sidchat1 @UNDPKenya

4 | Learn from the places getting it right

Ghana’s health system isn’t the best I’ve seen but they’ve got some very fundamental things right and have been continually improving over many years. Some of the fundamentals are a commitment to all Ghanaians getting quality, affordable healthcare, and trying to create a national-level risk pool – so the healthier and wealthier subsidise the sicker and poorer. From small-scale experimentation with community-based health insurance, they scaled up to national health insurance, and are now working through the tough challenges of purchasing health services more strategically and sustainably for everyone. The private sector plays a significant role in Ghana’s healthcare provision – a recent World Bank study of Ghana’s private sector noted that Ghanaians access care from private sources more than half of the time. Cicely Thomas, senior programme officer, Results for Development, Washington DC, US @results4dev @cicelysimone

5 | Raise taxes to reach the poorest

In the majority of developed countries, health services are mostly private. But they are publicly regulated and financed. What we have learned over time is that an equitable system always relies on cross-subsidy, from rich to poor and from healthy to sick. Progressive taxation and public subsidy to ensure access to services is the essence if we want to reach universality of access to health services. Agnes Soucat, director, health financing and governance, World Health Organisation, Geneva, Switzerland @asoucat @WHO

6 | Don’t focus on arbitrary targets for health spending

The Abuja declaration expects African governments to spend 15% of GDP on healthcare. That’s not easy to do – and is not essential. Singapore spends about 5% of GDP on healthcare and has done a fantastic job in ensuring every citizen has access to a good quality service. Sri Lanka spends between 3%–5% and India is pushing for 2.5%. But the question should be about what can you do best with what you can afford to spend. There is no magic GDP number that will deliver UHC since every country has varied resources. Ultimately it is not only about more money, but also how you end up spending your existing health budget that matters. Resources are often misspent in the health sector with an inordinate focus towards hospital care. Siddharth Chatterjee and Priya Balasubramaniam

7 | Invest more in preventing people getting sick

Health is not just the remit of health ministries – sanitation, housing, welfare and education are just a few of the bedrocks of improving population health. We shouldn’t think of healthcare as a pill or a hospital or programme to treat a single disease. Healthcare is clean water and a diet that does not place you at risk of diabetes or stunting. Healthcare is the education you need to find work and pay for a safe and warm home for your family. Healthcare is delaying early marriage and early pregnancy for vulnerable girls. Prevention has been relatively neglected in our policy priorities. Perhaps because prevention activities can seldom be charged for and people are not yet sick so it can be hard to convince both the public and policymakers of the benefits of preventative measures, even though prevention is usually the most cost-effective way to address disease. Jolene Skordis

8 | Make tackling individual diseases have a wider impact

In resource-limited settings, what health initiatives can catalyse overall healthcare systems strengthening? Vertical initiatives anchored to one disease, such as the focus on HIV through PEPFAR and Global Fund, have led to broader health-system strengthening by alleviating the HIV burden as well as increasing outcomes in mother-to-child transmission. Anand Reddi, corporate and medical affairs, Gilead Sciences Inc, San Francisco, US @ReddiAnand @GileadSciences

9 | Focus on equity, not just the number of people reached

If we look back at the millennium development goals it is clear that the focus on reaching big numbers has had a detrimental effect on equity. Too often, national policies do not specifically address how marginalised groups will be reached by development programmes in order to benefit from the new facilities and services provided. This problem is often made worse in low-income areas where the services are offered on a cost recovery basis. Helen Hamilton, policy adviser for health, Sightsavers, Haywards Heath, UK @HelenCHamilton @Sightsavers_Pol

10 | Be honest about how money shapes healthcare decisions

India’s case (and that of South Africa, Brazil and the US) proves how users of a health services are often not the best judge of health services. We rely on doctors to tell us what care we need. If doctors can profit from giving us incorrect advice, they may well do so – particularly if there is little harm likely to be done (eg sending paying patients for extra, unneeded tests or procedures). This results in the cost of care increasing rapidly in the private sector, to the point where even the middle classes can’t afford health insurance in South Africa and the US. We need to remove the profit motive from healthcare if we want efficiency and effectiveness. Jolene Skordis

11 | Accept that political will trumps everything

If we want to bridge the gap between current healthcare provision and achieving UHC globally, we must not forget the importance of the political climate and landscape in countries. Many countries (including the US) have come up with innovative ways to work towards UHC, and have qualified professionals to manage their health systems. However, without the political will to do so, they continue to struggle. Cicely Thomas

Read the full Q&A here.

Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.

How to make global universal healthcare a reality


1 | Accept there’s no such thing as a ‘perfect healthcare model’

All healthcare models have their challenges in terms of systems capacity, fiscal space and good governance. I think the progress of countries like Thailand and Sri Lanka towards universal health is certainly laudable, but they each have different approaches to getting there. Thailand’s journey began incrementally and over the years through consistent investment in Primary Health Care (PHC). Meanwhile, India is more focused on achieving Universal Health Care (UHC) through mixed health markets featuring both public and private sector players. Priya Balasubramaniam, senior public health scientist and director, PHFI-RNE Universal Health Initiative, Public Health Foundation of India, New Delhi, India

2 | Have the same healthcare provider for the rich and the poor

If we have dual systems with the “national service” caring for the poor and the private sector caring for the rich, quality will be an afterthought. We need the rich and poor to be cared for by the same provider – this ensures that high quality will be a political priority as those with voting influence are directly affected by the quality of services provided. Jolene Skordis, director, UCL Centre for Global Health Economics, London, UK @JSkordis

3 | Give public-private partnerships serious consideration

The PPP model needs to be taken to scale in PHC in order to achieve UHC in a planned time frame. I have worked in many parts of the developing world and in general governments have not been able to step up. Now is the time to test new models as the old system is not working. We need a blended service delivery mechanism. We have to open up the insurance space and governments must push for universal insurance cover for all citizens. This is what we’re trying to do in Kenya. Siddharth Chatterjee, resident coordinator to Kenya, United Nations, Nairobi, Kenya @sidchat1 @UNDPKenya

4 | Learn from the places getting it right

Ghana’s health system isn’t the best I’ve seen but they’ve got some very fundamental things right and have been continually improving over many years. Some of the fundamentals are a commitment to all Ghanaians getting quality, affordable healthcare, and trying to create a national-level risk pool – so the healthier and wealthier subsidise the sicker and poorer. From small-scale experimentation with community-based health insurance, they scaled up to national health insurance, and are now working through the tough challenges of purchasing health services more strategically and sustainably for everyone. The private sector plays a significant role in Ghana’s healthcare provision – a recent World Bank study of Ghana’s private sector noted that Ghanaians access care from private sources more than half of the time. Cicely Thomas, senior programme officer, Results for Development, Washington DC, US @results4dev @cicelysimone

5 | Raise taxes to reach the poorest

In the majority of developed countries, health services are mostly private. But they are publicly regulated and financed. What we have learned over time is that an equitable system always relies on cross-subsidy, from rich to poor and from healthy to sick. Progressive taxation and public subsidy to ensure access to services is the essence if we want to reach universality of access to health services. Agnes Soucat, director, health financing and governance, World Health Organisation, Geneva, Switzerland @asoucat @WHO

6 | Don’t focus on arbitrary targets for health spending

The Abuja declaration expects African governments to spend 15% of GDP on healthcare. That’s not easy to do – and is not essential. Singapore spends about 5% of GDP on healthcare and has done a fantastic job in ensuring every citizen has access to a good quality service. Sri Lanka spends between 3%–5% and India is pushing for 2.5%. But the question should be about what can you do best with what you can afford to spend. There is no magic GDP number that will deliver UHC since every country has varied resources. Ultimately it is not only about more money, but also how you end up spending your existing health budget that matters. Resources are often misspent in the health sector with an inordinate focus towards hospital care. Siddharth Chatterjee and Priya Balasubramaniam

7 | Invest more in preventing people getting sick

Health is not just the remit of health ministries – sanitation, housing, welfare and education are just a few of the bedrocks of improving population health. We shouldn’t think of healthcare as a pill or a hospital or programme to treat a single disease. Healthcare is clean water and a diet that does not place you at risk of diabetes or stunting. Healthcare is the education you need to find work and pay for a safe and warm home for your family. Healthcare is delaying early marriage and early pregnancy for vulnerable girls. Prevention has been relatively neglected in our policy priorities. Perhaps because prevention activities can seldom be charged for and people are not yet sick so it can be hard to convince both the public and policymakers of the benefits of preventative measures, even though prevention is usually the most cost-effective way to address disease. Jolene Skordis

8 | Make tackling individual diseases have a wider impact

In resource-limited settings, what health initiatives can catalyse overall healthcare systems strengthening? Vertical initiatives anchored to one disease, such as the focus on HIV through PEPFAR and Global Fund, have led to broader health-system strengthening by alleviating the HIV burden as well as increasing outcomes in mother-to-child transmission. Anand Reddi, corporate and medical affairs, Gilead Sciences Inc, San Francisco, US @ReddiAnand @GileadSciences

9 | Focus on equity, not just the number of people reached

If we look back at the millennium development goals it is clear that the focus on reaching big numbers has had a detrimental effect on equity. Too often, national policies do not specifically address how marginalised groups will be reached by development programmes in order to benefit from the new facilities and services provided. This problem is often made worse in low-income areas where the services are offered on a cost recovery basis. Helen Hamilton, policy adviser for health, Sightsavers, Haywards Heath, UK @HelenCHamilton @Sightsavers_Pol

10 | Be honest about how money shapes healthcare decisions

India’s case (and that of South Africa, Brazil and the US) proves how users of a health services are often not the best judge of health services. We rely on doctors to tell us what care we need. If doctors can profit from giving us incorrect advice, they may well do so – particularly if there is little harm likely to be done (eg sending paying patients for extra, unneeded tests or procedures). This results in the cost of care increasing rapidly in the private sector, to the point where even the middle classes can’t afford health insurance in South Africa and the US. We need to remove the profit motive from healthcare if we want efficiency and effectiveness. Jolene Skordis

11 | Accept that political will trumps everything

If we want to bridge the gap between current healthcare provision and achieving UHC globally, we must not forget the importance of the political climate and landscape in countries. Many countries (including the US) have come up with innovative ways to work towards UHC, and have qualified professionals to manage their health systems. However, without the political will to do so, they continue to struggle. Cicely Thomas

Read the full Q&A here.

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Nine ways to save the NHS – by healthcare professionals

1. Charge drunk people for using services

Drink- or drug-related problems should always be dealt with in regional drunk tanks which are already being used in many areas, and patients charged to make the service profitable. Alternatively, this could be paid for by a sharp rise in alcohol tax. In the A&E I often work in, it’s not just the weekend evenings we have drunk patients, it’s 24/7; you can walk in at any time of day and there will always be a few drunk people or drug users causing a nuisance.

2. Fine people for appointments they miss or cancel at short notice

About 10% of all NHS appointments go to waste as patients do not turn up for them – this should result in a fine. About a further 10% of all NHS appointments go to waste due to patients cancelling them at the last minute and not giving us any time to fill them. In reality up to 20% of NHS appointments go to waste due to patients not attending or cancelling at the last minute. There should be a charge for cancelling an appointment with short notice like dentists have.

NHS administrator, Bristol

3. Give money to public health and social care instead of the NHS

More money needs to be spent on prevention and incrementally less on the NHS. Give the funds to public health and social care and we’ll see less demand and fewer issues in the NHS.

4. Create a competitive market for GPs and community services

Create a more open and competitive market for community and GP services. Current NHS GPs are private contractors riding the gravy train with no real competition. They have no real interest in improving the situation. When patients have choice and the money follows the patient, services will take notice.

5. Centralise key services and improve IT

Centralise more key services such as procurement. We do not need hundreds of hospitals all procuring rubber gloves and pencils locally with hundreds of variations. Use the buying power of the NHS to drive down costs.

Force GPs and hospitals to use email (as a minimum) for internal correspondence. They are costing the NHS hundreds of millions of pounds and there are no valid excuses. Mandate that GPs and hospitals offer patients the choice of email for communications and clinical correspondence. It is not acceptable to refuse on spurious and plain wrong security grounds.

Senior manager, London

6. Introduce an all-party parliamentary committee working with all NHS staff groups

Introduce an all-party parliamentary committee working with all staff groups in the NHS, including managers and clinicians. Recommendations should be road-tested with patient groups; and then go out to public consultation. This may help stop the interference of politicians, in terms of reorganising the NHS at vast cost, causing confusion and prompting good staff to leave. This should not be all about cost-cutting (as I believe the current Sustainability and Transformation Plans are) but about a realistic vision for the long-term future of the NHS, building in assured funding for at least a 10-year period. It should protect services free at the point of delivery but also be radical in terms of how to raise revenue; the important point being that it is a collaborative exercise, including genuine public consultation.

Former engagement and communication manager, Lancashire

7. Bring back training bursaries for nurses and give them a pay rise

Bring back nurse training bursaries, and give nurses a pay rise. There should be more nurse involvement with management decisions and more patient involvement generally. We need better training for managers and to drop all privatisation plans; to look at successful models and pathways of treatment worldwide then implement them; fewer different computer systems; better communication between all professionals. We should actually enforce recommendations resulting from complaints, enquiries etc, encourage whistleblowing and shouldn’t persecute those who do it.

Mental health nurse, Lincolnshire

8. Introduce a nominal charge to access services

Break down barriers between different parts of health and social care. Reduce political influence. We need better models of working together between clinicians and non-clinicians. There should be a nominal charge to access services – introduce a £1 charge – mirror what the 5p plastic bag charge did. Inform patients how much their care is costing the NHS at every access point.

GP, North West

9. Make doctors surgeries open longer so people avoid A&E

Make doctors surgeries open longer or have easily available walk-in centres so people don’t go to A&E for minor ailments – education is not working in this area. Connect healthcare with social care on hospital discharges.

Therapy assistant, Yorkshire

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