Two countries divided by a common language: health systems in the UK and USA

The review is published in the Journal of the Royal Society of Medicine (JRSM).

The review, by the London School of Hygiene & Tropical Medicine's Monica Desai, Bernard Rachet, Michel Coleman and Martin McKee, discusses the historical significance of the USA's healthcare reform bill. This is still under attack from many commentators in the USA and even from a UK Conservative politician who referred to the National Health Service as a "60-year mistake." One editorial even argued that scientist Stephen Hawking wouldn't have a chance in the UK, where they say the "life of this brilliant man ...is essentially worthless."

Americans currently pay three times as much as British people for healthcare -- around £6,700 per person per year -- but while the number of doctors is similar in both countries (26 per 100,000 population in the USA and 23 in the UK), the UK has significantly higher numbers of nurses and midwives and hospital beds. Neonatal, infant and maternal mortality rates are all higher in the USA than in the UK. There are also significant problems for those on lower incomes: with one in seven Americans currently lacking insurance coverage, the situation could only get worse for those at the lowest end of the social scale.

Higher cancer survival is often quoted as a reason why the current American system is preferable to the NHS, but although survival amongst older people with cancer is better in the USA, outcomes among young people with chronic diseases are worse in the USA. Significantly, the section of the American health system which most closely resembles the UK National Health Service, the Veterans' Administration, achieves the best results, with little or no difference in outcomes by race or insurance status.