Health System of United Kingdom ☆ R Surender, University of Oxford, Oxford, UK KY Matsuoka, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA PV Ovseiko, University of Oxford, Oxford, UK ã 2015 Elsevier Inc. All rights reserved. Health and Health Care in Britain 1 Health Services Prior to the NHS 1 The Creation of a National Health Service 2 The Rise of the Market in Health Care 2 1997: The New NHS? 2 UK Political Devolution and Health Policy Divergence 3 2010: Liberating the NHS 3 The NHS Today 4 Funding 4 Expenditures 4 Capacity and Use by Service Sector 5 Private Health Care 5 Current Issues and Key Concerns for the NHS 5 Rationing 6 Evidence-Based Medicine 6 Health Inequalities 7 Health Promotion 8 Conclusion 8 References 8 Health and Health Care in Britain Health care is one area in which Britain since 1945 has experienced a quite distinctive arrangement compared with other Western industrialized societies. In 1948, a single health service funded from general taxation was established with aspirations to provide comprehensive and universally available health care. This National Health Service (NHS), which was to be available to all and not based on the ability to pay at the point of delivery, has continued to dominate the British health-care system ever since. By comparison, most European countries have developed similarly extensive health systems but have relied mainly on social insurance as their form of funding, and the United States has largely confined public funding of health care to two groups, the elderly and the poor. This article examines the emergence and development of this unique form of health service and considers the many pressures and changes it has faced. Also assessed are trends in the health of British society over this period. Health Services Prior to the NHS To understand why a single, publicly funded health service was established after the Second World War, it is essential to examine the state of health-care facilities prior to this event. Before the NHS, Britain’s health-care system was a disorganized and complex mixture of private and public services. Following the 1911 National Insurance Act, approximately 40% of the working poor were entitled to free primary health care from a general practitioner (GP), although this scheme did not cover their hospital care or any health-care needs of their families. Two main forms of hospital existed: the voluntary hospital (established by philanthropy or public subscription) and local authority or municipal hospitals (which evolved out of Poor Law hospitals). Both kinds of hospitals typically gave treatment to the poor free of charge, but admission was selective and both struggled to finance adequate services. By the end of the Second World War, several concerns surrounding the state of the nation’s health care emerged. Key among them was that over half the population was not covered by national insurance and had inadequate access to even basic primary care. Major reports commissioned at the time drew attention to the low overall standards of health in Britain, shortages of hospital facilities, and the uneven nature of provision across the country. The high levels of civilian and military casualties resulting from the war further exposed the weaknesses of the system. ☆ Change History: October 2014. PV Ovseiko introduced small edits in the text of the article; updated the sections “1997: The New NHS?,” “The NHS Today,” and “Health Promotion,” Figures 1 and 2, Tables 1 and 2; and added the sections “UK Political Devolution and Health Policy Divergence” and “2010: Liberating the NHS”. Reference Module in Biomedical Research http://dx.doi.org/10.1016/B978-0-12-801238-3.02976-7 1