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The United Kingdom ranks only 17th out of 29 countries in the latest edition of the Euro Health Consumer Index of public healthcare systems—one place behind Ireland and narrowly ahead of Italy and Portugal. It has slipped from 15th position last year.year.
The rankings, now in their third year, were produced by the Brussels based analysis and information organisation, Health Consumer Powerhouse. They are based on 27 indicators grouped into five categories—patients' rights and information, waiting times, outcomes, the generosity of public healthcare systems, and access to medication.
The UK, with its electronic patient records, quality ranking of hospitals provided by the Healthcare Commission, and 24 hour telephone healthcare information system provided by NHS Direct is in the forefront of patient access to information. However, it scores badly on access to new treatments and long waiting times, receiving only 581 points out of a potential 1000.
Arne Björnberg, the index's director, said that “Patients in the UK have the right to expect more. Despite substantial funding increases, the UK is still a mediocre overall performer.”
Top slot with 806 points went to Austria, which scored consistently well across the five categories. The Netherlands, which topped the league in 2006, is in second place, closely followed by France, Switzerland, and Germany. At the bottom of the table are Latvia, Bulgaria, and Poland.
In the individual categories Denmark was the winner on patients' rights and information; Belgium on waiting times; Sweden on outcomes; Finland, France, Hungary, and Sweden on generosity of systems; and Denmark, Ireland, the Netherlands, Spain, Sweden, and Switzerland on access to medicines.
In general, the survey found that increasing attention is being paid to patients' rights and that healthcare provision is improving. However, it notes that methicillin resistant Staphylococcus aureus infections in hospitals seem to be spreading and that half of the health services delay consumer access to new medicines.
In the debate between the Bismarck healthcare system, based on social insurance with many insurance organisations, and the Beveridge variety, where financing and provision are handled in one organisational system, as in the UK, the survey indicates that the former delivers better value.
“It is very hard to avoid noticing that the top five countries, which fall within 36 points on a 1000 point scale, all have dedicated Bismarckian healthcare systems. There is a gap of 30 points to the first Beveridge country in sixth place,” notes the commentary accompanying the index.
The authors of the survey acknowledge that the countries covered have very different levels of health expenditure, ranging from about $600 (£300; €420) per capita in Bulgaria and Romania to more than $4000 in Norway, Switzerland, and Luxembourg. Reflecting this, they have drawn up a value for money table. This is led by Estonia, but includes Austria, the Netherlands, France, and Germany in the top six. The UK is in 26th place.
Commenting on the table, John Appleby, chief economist at the King's Fund, said, “These composite performance tables are problematic. One of the problems is that different weighting has to be given to different components, according to what is thought to matter to patients. But that is often hard to know.
“In these tables, the focus is on acute care, with no indicators reflecting how health systems perform on mental health care or services for the elderly, sectors which account for significant proportions of all health services.
“For a performance index aimed at consumers there is also a surprising lack of any consumer view about health services.
“As far as waiting times are concerned, research also shows that when they get below a certain level [about three months], any improvements make little difference to patients.”
The weightings given to the different components in the survey were 1.5 for patients rights and information, 2 for waiting time, 2 for outcomes, 1 for generosity, and 1 for pharmaceuticals.