This Key Note Market Review analyses the healthcare market in the UK, which can be divided broadly into public healthcare (the NHS, which comprises hospital and community health services [HCHS] and family health services [FHS]), private healthcare (and private medical insurance [PMI]), and other healthcare services (covering complementary and alternative medicine [CAM] and palliative and hospice care). Key Note estimates that, in 2005, the total UK healthcare market will be worth £111.42bn, an increase of 8.9% on 2004.
Since its inception in 1948, the UK healthcare market has been dominated by the significant, comprehensive NHS. When the NHS was established with the remit to provide healthcare based on need rather than the ability to pay, there was no conception of how much costs would rise as the boundaries of healthcare expanded, along with the increasing number of elderly people in the population. In spite of the problems in funding and delivery, the British public remain fiercely protective of the NHS and politicians are aware that any significant erosion of the central principles of the NHS will have a huge political cost. At the same time, governments have had to grapple with the key issues of limited resources, prioritisation of care and, most importantly, how best to deliver healthcare in the most cost-effective and efficient way without compromising the principles of the NHS.
Key Note estimates that, in 2005, the NHS will account for 80.7% of total UK expenditure on healthcare services. The NHS is organised into two main service delivery organisations:
In the UK, the private healthcare sector has evolved in the shadow of the significant public sector, largely through supplying solutions to the problems in the NHS. As a result, much of the private-sector provision is traditionally for routine elective procedures, which are likely to have longer waiting lists on the NHS. The private sector has also developed niche markets, such as cosmetic surgery, abortion services and fertility treatment, which are either limited or unavailable on the NHS. More recently, the private sector and the NHS have been working in partnership, supplying services to reduce waiting lists for the NHS or running services for the NHS directly, such as long-term care, certain psychiatric care services and specialist diagnostic services. Primary care services, particularly occupational health, are also a relatively small, but emerging, market in the private healthcare sector.
In 2005, Key Note estimates that private healthcare services (excluding PMI) accounted for 15.3% of healthcare expenditure in the UK. By far the largest private sector market was that of long-term care. PMI remains the principal source of funding for the private healthcare sector, although the NHS has become a significant commissioner of private-sector services and many private patients are opting for self-pay fixed-price schemes.
CAM comprises a significantly diverse range of therapies and treatments, of which some, such as chiropractic and osteopathy, have achieved statutory recognition and regulation. Others have little or no regulation outside the voluntary self-regulation of a large number of different trade organisations. A number of the more popular complementary therapies, including osteopathy, chiropractic, acupuncture, reflexology and aromatherapy, are becoming increasingly integrated into mainstream care. Homeopathy is available in a number of NHS hospitals, in spite of the scepticism of many healthcare professionals.
Palliative and hospice care, although a comparatively small sector of the market in terms of expenditure, is also hugely influential. Largely run by charities and voluntary organisations, the palliative and hospice care sector has had funding problems, coupled with increasing demand for services. However, there has been increasing recognition from the public sector in terms of funding and the development of more integrated partnerships in care with, or actually within, the NHS. In particular, the palliative care sector has been developing more flexible community-based services, with the emphasis on home and respite care.
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