One world, one (healthcare) problem: The UK’s “personal shopper”
One world, one (healthcare) problem: The UK’s “personal shopper”
One idea for when health care is as alien as psychedelic produce offerings
One world, one (healthcare) problem: The UK’s “personal shopper”
Improving health is a universal goal, but equally universal are the challenges to providing this care in a modern health care system. In this series, we’ll examine a problem faced by every healthcare system and highlight one country that effectively solves it. Last time, we saw how Canada sidesteps having insurance markets spiral to only cover the sickest patients. Today, how the UK tackles the tough problem of information and saves money in the process.
1. Shopping is tough in an unfamiliar market.
Imagine your weekly grocery shop, with your favorite meal plan and an ingredient list. Now imagine that, instead of your favorite neighborhood grocery store, you’ll be doing that shopping at an unfamiliar ethnic specialty market. The bags of rice might look familiar, but you have no idea where they are, and some of the produce looks like a flamboyant alien who crash-landed from a psychedelic galaxy. Feeling a little overwhelmed?
Being a patient buying medical care can be a similar experience, You know your symptoms, but not the full space of medical treatments necessary to address them. And you can’t evaluate their quality if they are as alien to you as a psychedelic dragon fruit. All health care systems must confront the problem that choosing and evaluating quality in health care requires more information than an average patient knows. In such an unfamiliar market, what kinds of services should be available and consumed?
2. Basics of the UK system
Ethnic markets are a lot easier to navigate with a friend from that culture, right? The UK system copies this by essentially becoming a personal shopper for its citizens. The system is based around public contracting, where the government organizes and negotiates with health care providers on behalf of its citizens.
The “personal shoppers” in the UK National Health Service are 42 entities called Integrated Care Systems (ICSs), which plan, commission, and pay for most hospital and community care services for a planning area of about 1.5 million people, on average. One part of the ICS, the Integrated Care Partnership, develops a high level, medium-term plan for improving the health in their particular geography, much like your meal plan. A second part of the ICS, the Integrated Care Board, arranges for provision of specific health services and manages the NHS budget allocated to the ICS area, somewhat like your ingredient list and household budget. [1],[2]
Finally, to evaluate the quality of services, the UK NHS has a committee called the National Institute for Health and Care Excellence (NICE- that’s really the name, not my joke this time!). NICE is an independent expert body tasked with appraising the cost-effectiveness of medicines and services, serving as a gatekeeper by maintaining the list of approved cost-effective choices.
3. Rating the stand-in, your personal shopper
To evaluate the UK system, we need to rate this personal shopper for our overwhelmed customer. Does it provide what you need to buy, choose high quality goods, and keep to your budget?
The question of what to buy drove one of largest modern reforms in the UK in 2022, leading to the new ICS entities. Like other Western systems, the UK’s ballooning costs of chronic conditions highlight the dearth of preventive approaches to health. The reformed high-level regional planning is supposed to create a more integrative and proactive approach to prevention and health disparities, though it will take several more years to see if real change has occurred.
As for quality, the UK’s NICE agency is a stark implementation. Unlike the U.S., where treatment coverage varies and even the most expensive treatments may be performed somewhere, the UK specifically disallows those services where costs cannot justify the medical benefits. Keeping this strict quality threshold feeds back to keeping to a budget by using medical funds most effectively. This cost-benefit cutoff is not popular in the U.S. (it has been re-branded as “value-based care”), but our tradeoff is health care costs twice as high as our peers.
Although the biggest disadvantage of the UK system is that there is only one personal shopper- leading to fewer choices and shortages of providers- the cost control benefits of the personal shopper have come to fruition. (See what I did there?) The UK spent $5,387 per capita in 2021, nearly $700 less per person compared to the average of industrialized healthcare systems (and less than half of US spending). The UK’s system of informed government contracting on behalf of less-informed citizens has received positive ratings as a shopper by maintaining a baseline quality of care while still holding down spending per capita.
Read the others in this series: Germany is a meister of choice, Canada deftly avoids the death spiral, and Switzerland’s markets of plenty.
[1] Dunn, Pheobe et al. “Integrated care systems: what do they look like?” The Health Foundation. June 15, 2022.
[2] National Health Service England. “What are Integrated Care Systems?”