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11% buy supplemental coverage for faster access to care, choice of specialists and better services, especially for elective hospital procedures.
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No overall cap. Those who require a large number of prescription drugs can purchase prepaid certificates for unlimited use that cost GBP 29.10 (US$41.4) per quarter or GBP 104 (US$148) per year.
Drug Cost Sharing Waivers: People with low incomes, the elderly, children, pregnant women, new mothers, and some with disabilities or chronic illnesses.
Mainly private, paid for by a combination of capitation, FFS, PFP; ~22%) are resident physicians employed by private group practices. Goalkeeper rolls. Patient registration is required.
Public: Up to £9,250 per year for UK citizens; usually between £25,000 and £40,000 per year for international students
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All English residents are automatically entitled to free public health care through the National Health Service, including hospital, medical and mental health care. The budget of the National Health Service is mainly financed by general taxes. A government agency, NHS England, oversees and allocates funds to 191 clinical commissioning groups, which monitor and pay for care at the local level. Around 10.5 per cent of the UK population have voluntary supplementary insurance to gain faster access to elective care.
Health coverage in England has been universal since the creation of the National Health Service (NHS) in 1948. The NHS was established under the National Health Service Act 1946, based on the recommendations of a report to Parliament from Sir William Beveridge in 1942. The Beveridge report described free health care as one aspect of a broader welfare reform designed to eliminate unemployment, poverty, and disease, and improve education. Under the 1946 Act, the Minister of Health had a duty to provide a comprehensive and free health service that would replace voluntary insurance and direct payments.
Currently, any "usual resident" in England is automatically entitled to NHS care, which remains largely free, as are non-residents with a European Health Insurance Card. For other people, such as non-European visitors or undocumented immigrants, only treatment in an emergency department and for certain infectious diseases is free.
The rights of people eligible for NHS care are outlined in the NHS Constitution; this includes the right to access care without discrimination and within certain time limits for certain categories, such as emergencies and scheduled hospital care.
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Role of Government: Responsibility for health legislation and general policy in England rests with Parliament, the Secretary of State for Health and the Department of Health. Day-to-day responsibility for the NHS rests with NHS England, an independent body funded by the government and administered separately from the Department of Health.
The government owns NHS hospitals and care providers, including ambulance services, mental health services, district nursing and other community services. These providers are called NHS Trusts.
Role of public health insurance: In 2016, the UK spent 9.8% of GDP on health care; public spending, mainly related to the SNS, represented 79.4 percent of this amount.
The majority of NHS funding comes from general taxes and a smaller proportion (20%) comes from National Insurance, which is a payroll tax paid by employees and employers. The NHS also receives income from co-pays and from people who use NHS services as private patients.
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Role of private health insurance: In 2015, about 10.5 per cent of the UK population had private voluntary health insurance, with nearly 4 million policies held at the beginning of 2015.
Employers offer some private insurance, but individuals can also purchase policies. Private insurance offers faster access to care, choice of specialists, and better facilities, especially for elective hospital procedures; however, most policies exclude mental health, maternity services, emergency care, and general practice.
According to a 2014 survey, four insurers account for 87.5 percent of the private insurance market, with the rest being small businesses.
Covered services: The exact range of services covered by the NHS is not defined in statute or law, and there is no absolute right for patients to receive specific treatment. However, the statutory duty of the Secretary of Health is to ensure comprehensive coverage.
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Cost-sharing and out-of-pocket costs: The NHS has very limited cost-sharing arrangements for publicly covered services. Services are free at the point of use for inpatient and outpatient hospital services. Out-of-pocket payments for doctor visits only apply to certain services, such as delivery of certificates for insurance purposes and travel vaccinations. NHS screening and vaccination programs are not subject to co-payments.
Outpatient prescription medications are subject to a GBP 8.80 (USD 12.50) copay per prescription. Prescription drugs in NHS hospitals are free.
NHS dental services are subject to copays of up to GBP 256.50 (USD 365.00) per treatment cycle.
Household out-of-pocket spending on health accounted for 15% of total spending in the UK in 2016. Also in 2016, the largest proportion of out-of-pocket spending (37%) was on long-term care services, including residential care by 35 percent for medical products (including pharmaceuticals).
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Patients requiring large quantities of prescription drugs can purchase prepaid certificates costing GBP 29.10 (US$41.40) for three months and GBP 104 (US$148) for 12 months. Users incur no additional costs during the life of the certificate, regardless of how many prescriptions they need.
Other safety nets include assistance with dental and vision care. Youth, students, pregnant and newly pregnant women, inmates, and low-income individuals are not subject to dental copays. Eye exams are free for young people, people over 60 and people with limited resources. Also, youth and low-income people can get financial support to cover the cost of corrective lenses.
Transport costs to and from provider sites are also covered for people who qualify for the NHS Low Income Scheme.
Physician Training and Workforce: There is a growing physician shortage, affecting primary care and certain specialties. In 2016, the government promised an additional 5,000 GPs by 2021, including new trainees, recruits from abroad and doctors returning to practice.
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Financial incentives were made available to interns and returnees to attract physicians to areas with shortages, including rural and urban areas.
The number of university places for undergraduate medical and dental degrees is regulated by the government: in 2018-2019, there were a total of 6,700 places available for medical degrees at public universities in England.
This is 500 more spaces than were available in 2017-2018. Over time, the government has committed to expanding the number of undergraduate training places by 25 per cent to address labor shortages.
University degrees are funded by student fees and government subsidies. The rest of the medical training (four to six years) is financed by the government.
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Primary care: Primary care is mainly provided by general practitioners, who act as gatekeepers to secondary care. General practices are often the first point of contact for patients, and individuals must register with a local practice of their choice; however, the choice is effectively limited because many practices are full and not accepting new patients. In some areas, outpatient centers offer primary care services, for which registration is not required.
As of September 2017, there were approximately 34,000 general practitioners (full-time equivalents) in nearly 7,400 practices, averaging approximately 8,000 patients per practice and 1,400 patients per general practitioner.
The majority of general practitioners (59.4 percent) are private contractors (self-employed). The proportion of GPs employed on a trainee or salaried basis as a substitute (substitute when no other GPs are available) is increasing and is currently around 22 per cent.
The majority (69%) of practices operate under General Medical Services contracts, negotiated between the British Medical Association (representing doctors) and the government. The doctor's payment is about 60 percent capitation for essential services, about 15 percent payment for additional optional services (such as vaccinations for at-risk populations), and about 10 percent performance-related payments.
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Capital is adjusted for age and gender, local levels of morbidity and mortality, number of patients in nursing homes and residences, patient roster turnover, and a market power factor for staff costs compared to those of other practices. Performance bonuses are awarded primarily on evidence-based clinical interventions and care coordination for chronic conditions.
General practice is undergoing structural change, from one-handed corner stores to networked practices, including larger organizations using multidisciplinary teams of specialists, pharmacists, and social workers.
The average income of GPs (contracted and salaried) in England was GBP 92,500 (USD 131,579) before tax in 2015-2016, with GPs earning 82% of what specialists earn.
Most general practices employ other paid professionals, such as nurses, whose duties include managing patients with long-term conditions and providing minor treatments. As of December 2017, there were around 15,800 nurses working in general practice.
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Outpatient specialist care: Almost all specialists are salaried employees of NHS hospitals. Salaries are agreed as part of a national contract between the Department of Health and the British Medical Association.
At the end of 2017 there were approximately 45,800 hospital specialists and 52,800 hospital doctors in training.
CCGs pay hospitals for outpatient consultations
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