By Susan Stewart, Licensed Insurance Agent
I lived in England for 10 years, worked, got a driver's license, joined a book club, and needed medical care. There, virtually all costs that we’d associate with health insurance here in the states are covered through the National Health Service (NHS), a government agency. The NHS is funded primarily by general taxation and secondarily by required employee contributions.
Last month, I wrote about how my experience with the NHS compared to my experience with the American healthcare system, focusing on how prescriptions differ. For this follow-up piece, drawing on my own experience rather than deep investigative reporting, I’ll share a few more observations on what works and what doesn’t work in the U.K. healthcare system in general.
Here are a few things that worked for me in the English healthcare system:
- I appreciated having healthcare at all. In America, I had spent years without health insurance because I was self-employed and could not afford it. Citizens, legal immigrants, and some refugees get “free” healthcare in the U.K.
- In the U.K., nobody goes bankrupt due to medical costs. You never have to worry about paying co-pays or co-insurance percentages.
- I required four surgeries, and the care I personally received was stellar.
- You choose a medical facility as your primary care provider. Mine opened at 8 a.m. and was first-come, first-served until 9 a.m. I could stand in line outside until they opened, see my doctor, and usually still get to work by 9 a.m. Not all facilities do that, but I appreciated that mine did.
However, several aspects of the U.K.’s socialized healthcare system were more challenging. Here are a few aspects of the English system that I struggled with:
- Primary Care appointments can be hard to get. Depending on the facility, it was not uncommon to be unable to get through, much less get a same-day appointment for a sudden-onset diagnosis like strep throat. One time, it took a friend two hours of calling to get through, only to be told they couldn’t schedule an appointment for three weeks. At the time, her only option was Accident and Emergency (A&E; equivalent to the ER). If English A&Es and American ERs have one thing in common, it’s long wait times.
- People needing any surgery that’s considered elective—even if it’s really not—can wait a year or longer due to the backlog. This can include procedures for the knees, the hips, and even the heart. I know someone who had to wait a full year for a heart ablation due to a lack of specialists to provide the necessary appointments, a shortage of techs to do the tests, and full surgery schedules at the hospital. Each appointment had to be scheduled weeks, even months, out. After that ordeal, I am glad my friend is still with us.
- Healthcare providers often threaten to strike due to low pay. Most nurses earn a fraction of what they do in the States. The U.K. asked its highest-paid specialists to retire early in 2018 and 2019. Then COVID-19 struck, leaving a shortage of providers, less experienced doctors, and burnout. Now, the U.K. must bring in nurses and doctors from other countries to address its staffing shortages.
- Dental care is not so accessible. Dentists are required to offer only a small percentage of their business for NHS payment. Waiting lists are very long to get into a dentist using the NHS. Most people must pay out of pocket for all their dental care.
Despite the challenges, my view of the NHS is fairly positive today, more than three years after returning to the U.S. I'm still stunned by the high cost of American healthcare—co-pays, co-insurance, deductibles, and the whole network system. I'll be eligible for Medicare this summer, but I will still work full-time, so maybe my perspective will change. Stay tuned.
