Welcome to my Heart Blog.

One Persons's journey to a Coronary Artery Bypass Graft (CABG) and hopefully beyond.

I Began this diary while I was sitting in hospital recovering from a quadruple coronary artery bypass graft (CABG). The aim was to track my progress and think a bit more about the National Health Service acute services, what we should appreciate about it and where we might do better.

I stopped writing when there was, frankly, not much else to record. However in June I signed up for a half marathon and thought I would re-open the blog as a training diary. It may even include a few health and exercise tips along the way.

I am neither a health-care professional nor a sports and fitness guru. What I write is no more expert than some of the things you might here from that bloke in the pub, so I take no responsibility for how you might use my ramblings. Be warned!

If you want to you can read the "back story", from hospital to rehab in earlier blog posts. One thing I have learned is that most people are not interested in reading my ramblings so, for those who do, I promise in future to keep them short.

Saturday, 4 July 2015

What does the UK spend on Healthcare and does it spend enough?

The UK spent 9.3% of GDP on health services in 2012, or on average USD 3,289 per person.  So is this a lot, enough, or too little? 

We always read in the press that the NHS is strapped for cash. The OECD publishes tables showing cost per head and as a percentage of GDP.  Rich countries are of course more likely to be willing to spend more on health than poorer ones simply because they can afford it.  However the figures of course indicate situation is a lot more complicated.  Germany and France spend over 2% more of GDP on health than the UK and Italy spends roughly the same as the UK.  Their nationalised health systems are organised quite differently, but do they deliver equal quality of care, better or worse?  Those who have experienced all seem to have different experiences.  But money means something, so lets just look at the figures.

The UK's GDP per head has broadly mapped that of the OECD as a whole.  Our spend % of GDP is also the same as the average for the OECD , which includes countries like Indonesia, Portugal or Greece with significantly lower GDP than the UK.  We are also at the bottom end of the range of the G7 richest countries in the world. 
 
The USA not surprisingly has a significantly higher health spend that any other country.  This contrasts with the expected life span numbers and morbidity (the likelihood of death from serious conditions, a better measure of health outcomes).  This probably reflects the well-known fact that the US system spends an awful lot on a insured and rich people (because insurance is usually capped, if you want the best treatment you must have cash to hand) at the top end, while outcomes at the bottom end amongst the uninsured or those depending on state funding, are much worse.

The question is why is there such disparity in effectiveness and cost between different countries in what is essentially an applied science?  The reality is surely that those countries that spend less may have chosen to spend less, though they may be trying to be more efficient.  And those countries that spend more do so because either they are incredibly inefficient or have chosen to build redundancy into their system to enable them to respond to emergencies and to address high-cost cares.

Perhaps the detailed figures present some other questions and answers, but at least we should know why the government thinks 9.3% of GDP is enough. 

2012 (unless otherwise stated) Data from OECD via Kings Fund,














Average age at death




USD per head
% GDP
Male
Female











USA
8745
16.9
                      76.3
                    81.1



Germany
4811
11.3
                    76.3
                    81.1



G7 average
4656
11.3
                    78.7
                    83.9



Canada
4602
10.9
                    79.3
                    83.6



France
4288
11.6
                    78.7
                    85.7



Sweden
4106
9.5
                    79.9
                    83.8



Japan
3649
9.5
                    79.4
                   85.9



OECD average
3478
9.3
                    77.5
                    82.8



UK
3289
9.3
                    79.0
                    83.9



Italy
3209
9.2
                    79.8
                    84.8



















Notes: G7 = the listed countries excluding Sweden. 





The OECD consists of 34 countries including all listed. The UK's GDP per head has been very similar to the average  for the OECD as a whole.  Countries such as Indonesia, Greece, Portugal lie significantly below the average.









NB: C2Morbidity (likely death rates from various medical interventions are probably a better measure than average life spans





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