BRITISH NHS

The National Health Service (NHS) came into being in 1948 and aims to provide good healthcare to all, regardless of wealth or age. It is provided and managed by a single payer — the British government, and is funded by the taxpayer. One of its strengths is that most UK doctors are on the government payroll, making it one of the most integrated-healthcare-systems in the world

Even though it seems to be a British past-time to complain about the NHS, most British can't imagine living without it. We will examine here how the NHS works, its origins and principles, and the options a British citizen has when abroad.

THE BRITISH HEALTH-CARE SYSTEM

Principles
The NHS is under the jurisdiction of the Department of Health, and its administration is rather complex and considered bureaucratic. For the patient though, it remains very simple and straight-forward. You are eligible for NHS cover if you are “ordinarily resident” in the UK. Residents choose a local general practitioner (GP) with whom you register, and when a problem occurs, you visit your GP, who will advise you and refer you on to a specialist if necessary. You can still go to the Accident and Emergency department of any hospital at any time, but if your situation isn't serious, you will have to wait.

Reimbursement
As the NHS is provided by a single payer, most medical needs are handled without monetary exchanges. The few exceptions to this principle are for medicine, appliances, ophthalmology, dentistry, and of course, if you choose to seek private medical care. In general, the NHS provides medical services as follows:

In-hospital treatment – All public hospitals provide a broad coverage of care to all without charging. Health care is given on the grounds of clinical need, meaning that emergency cases (e.g. heart attacks get instant access where those with less urgent needs (e.g. cataract surgery) are given lower priority, and so, wait longer.
Out-of-hospital treatment – If the patient is recommended by his GP, his consultation will be covered by the NHS. Should he wish to select his specialist, or go to him/her directly, then he will have to cover some or all of those expenses.
Medicine – Prescription charge for medicine is a flat £7.20 per item. If the patient is over sixty, under sixteen (or under nineteen if in full time education), or with low income or suffering a critical condition, he is exempt from paying. For repeated prescriptions one may purchase a single-charge pre-payment certificate which provides unlimited prescriptions during its period of validity.
Appliances, ophthalmic and dentistry – The NHS requires the patient to participate with these expenses depending on the particular treatment, and usually ranges from £16.50 for an examination to £198 for more complex procedures. Exemptions do apply for children, elderly, and low income families on welfare.

Funding
The NHS is funded out of general taxation and national insurance contributions for 90% of its budget, with the remainder from tobacco duty, and income generated from car park and other small charges. The total budget of the NHS is approximately £92.5bn for 2009, representing 6.5% of GDP.

Each division of the NHS is required to break even at year-end, so in theory, the service should never be in deficit. In recent years however, the NHS is in deficit. As Britons only spend about around 8.4% of GDP in health related expenses (compared with 11% in France, and 16% in the US) the UK still has some flexibility in how it tackles this funding.

Private Insurance
Only 11% of Britons take private health insurance. Many how do do so because they do not like or trust the NHS. For the majority who operate provate healthcare, their motive is predominantly to enjoy more freedom and flexibility when choosing their medical specialists and to avoid NHS waiting-lists for non-emergency procedures.

NHS Abroad
As the NHS is a residence-based healthcare system, once you have moved permanently away from the UK you are no longer entitled to medical treatment under normal NHS rules; it is therefore strongly recommended to take a private healthcare to cover your needs. Three exceptions exist to this recommendation:

If you are on a short term mission or secondment, you can keep your UK benefits by informing the NHS in advance. You must also continue to be paying UK tax and National Insurance contributions.
If you move to a European Economic Area country you can apply for a European Health Insurance Card (EHIC) which enables you to access healthcare while working in Europe.
If you are a Pensioner, Student, or receive benefits from the UK government, you may sometimes be entitled to state healthcare in your new country of residence, paid for by the NHS, and provided there exists a formalised arrangement between the two countries.

As we can see, those exceptions mainly work for British who move to another European country, or to a country with a similar national health system. As a result, British expats in Asia do need to get their own insurance to cover emergencies and expensive in-patient treatment.

YOUR INSURANCE OPTIONS

As the UK offers no international option for British expats under the NHS system, you truly have but two options:

Go local. Select a local provider who will cover you locally, and switch provider each time you move country. This solution has the advantages of being the cheapest, but it also means the level of cover will rarely be what you're used to, and when you move to another country, you will need to change provider in almost all instances, and as such your medical record will then be re-examined and considered with each new application.
Go international. International providers do offer packages replicating the level of cover you are used to back home and do follow you in your different postings around the world. In fact, the most famous international provider is British and does offer both private solutions in Britain and internationally: BUPA.

Both solutions have their pros and cons. If you wish to explore your options further, have questions, or need some guidance, give us a buzz .