Health care delivery in the United Kingdom and the United States: comparing notes and lessons.

T he systems of health care delivery in the United Kingdom and the United States were compared at the recent American College of Surgeons meeting in Chicago, Ill. The opening speaker, Anthony Giddings, MD, FRCS, introduced the session by outlining the development of the current National Health Service and provision of health care in the United Kingdom. Prior to its inception in 1948, there was marked inequality in the provision of health care to the wealthy and the poor. Wealth was held by a few and poverty was the lot of many. During both world wars, many of the conscripts to the armed forces were medically unfit because of poor social conditions, including medical care. The National Health Service was introduced in 1948 as a response to the social need; at the same time, it took over what were virtually bankrupt hospitals that were provided by the local councils. Consultants, who had previously relied on private practice for their income and treated patients in the hospitals, merely became salaried employees but retained the right to run a private practice. The concept of the National Health Service at its inception included the provision of universal care, competent treatment, and, above all, free service at the point of delivery. The architect of the National Health Service, Lord Beveridge, thought that it would reduce the need for treatment by practicing what should be described as preventive medicine. Unfortunately, this has not occurred as there is an increased demand in response to patients’ high expectations as well as advancing technology.