UK healthcare is already being privatised, but not in the way you think

In recent years, there has been a growing fear among certain sections of the British public that our much loved and strictly publicly funded National Health Service is at risk of being privatised. The NHS will be secretly sold by the dastardly Tours to US corporations in a cut price deal, or so the theory goes.

While the methods described may be fictional, it is not impossible to conclude from the data that a broader shift is happening. British healthcare is quietly inching into the private sector, and what is that it is least able to pay who are most concerned being away from the NHS.

If I told you that in the US, with its notoriously expensive healthcare system, the number resorting to crowdfunding campaigns to pay exorbitant private medical expenses has risen 20-fold in the past five years, I’m sure you wouldn’t be surprised. But those statistics don’t refer to the US, they refer to the UK.

Hundreds of Britons have launched GoFundMe campaigns so far in 2022 to raise money for private medical expenses, frequently citing their desperation after spending months or even years on NHS waiting lists. One Northern Irish family felt compelled to get private treatment overseas for their 12-year-old son’s curved spine after being told they would have to wait years by the NHS. They eventually raised £50,000 and the treatment was carried out successfully in Turkey.

Other cases include people suffering from debilitating hereditary disorders, career-derailing injuries and various forms of cancer, and all of whom feel the NHS is unable to meet their needs.

Chart showing that Britons now fork out almost as much as Americans on out-of-pocket healthcare spending

It is easy to paint the US healthcare experience as a capitalist dystopia, and the NHS as its socialist antithesis, but with each passing year this moves further from the truth. In 1990, out-of-pocket spending by Britons on medical expenses was equivalent to 1 per cent of GDP, while across the Atlantic, uninsured Americans forked out more than twice as much, at 2.2 per cent. Thirty years on, that gap has all but disappeared. Americans’ non-reimbursable spending now stands at 1.9 per cent, and Britons’ has doubled to 1.8 per cent.

Chart showing that in 2010, roughly 0.4% of UK household spending went on private hospital costs, with the richest spending the largest share on private care, but a decade later, private spending has more than doubled among the poorest, who now spends as much on hospital costs as the richest in relative terms

And the bulk of the increase in spending is from those who can least afford it. Between 2010 and 2020, the portion of UK spending that went on hospital treatments increased by 60 per cent overall, but more than doubled among the lowest-earning fifth of the population. The poorest now spend as much on private medical care as the richest, in relative terms.

One in 14 of Britain’s poorest households now incurs “catastrophic healthcare costs” in a typical year — where costs exceed 40 per cent of the capacity to pay. This is up from one in 30 a decade ago, coinciding with a period in which the share of the poorest who feel their healthcare needs are going unmet has risen from 1 per cent to 5 per cent.

Chart showing that in 2008, roughly one in 30 of the poorest UK households incurred 'catastrophic healthcare costs'.  By 2019, that had doubled to one in 14

For decades, droves of middle class Britons have gone private to get treated faster. This has always reflected their capacity to pay as much as the urgency of the need. But when thousands of people on low incomes feel forced to raise money from strangers to circumvent a struggling healthcare system, this is surely the starkest signal yet that the NHS is at breaking point.

john.burn-murdoch@ft.com

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