As the United States debates health-care reform, VOA is looking at health-care services around the world. 

The idea behind Britain's health-care system is straightforward, says Michael Summers of the non-profit Patients Association that helps people understand the National Health Service.

"Everyone is entitled to free health care at the time of need, both in relation to consulting their general practitioner, and to hospital treatment and operations.  It is free," he said.

Summers explains every worker in the country pays for it through a national insurance tax.  

"It is relatively cheap for what you get, and it has been in existence for 60 years, so it is well established as a health service and it works," he said. "It is not perfect, but then there is no country that has a perfect system."

Everyone is covered

One of its strengths is everyone is covered, says Fiona Wise, who runs three London-area hospitals.

"We provide care for elderly people, for mothers to be, for newborn babies, for children, and we provide long-term care for certain groups of patients who have what we would describe as chronic illnesses," said Wise.

Summers says the service takes care of people, not just in hospitals, but in doctors offices and dentists throughout Britain.

"It is vast, absolutely vast," he said.  "It is the biggest employer in the country.  It is said to employ more people than the Red Army, if that is a comparison.  It is vast, it costs an enormous amount of money, but of course it is funded from taxation and the contribution made by patients."


The sheer size of the service is at the heart of many complaints, such as long waiting times, canceled operations and poor nursing care.  

Errors by doctors who are either too pressed for time or inadequately funded are also a growing problem.  Studies indicate up to 15 percent of all patients in Britain are diagnosed incorrectly or have ailments that are overlooked.

Cancer specialist Dr. Karol Sikora says the quality of care is uneven, because local authorities decide which medications or treatments are available.

"Each of them has a different philosophy about heart disease, about cancer, about mental illness," said Sikora. "And the services you get, for whatever it is you need, depends critically on where you live.  We call this post-code prescribing."

Some patients have waged campaigns in the courts or the media in order to get access to treatment or medicine authorities have deemed too expensive, even if it prolongs life.  

Sikora says British authorities lag behind other European nations in making cancer drugs available.

"If they take three years to decide whether a drug for kidney cancer can be included or not, then that is three years of kidney cancer patients who cannot get the drug and that is what we have seen during the past several years," she said.


But having a national health-care service does have its advantages in some areas.  The British government's chief medical adviser, Liam Donaldson, says it makes organizing vaccinations and planning a response to flu outbreaks easier.

"We can, if necessary, be very centralized," said Donaldson.  "We can get stockpiles of anti-virals, we can distribute them to people, we can put a vaccine program in place and get very high levels of coverage.  When we have shortages in one part of the country - of beds or intensive-care beds - we can ensure that a network of services provides them in another part of the country."

But the critics and supporters agree one of the British national health service's biggest challenges, as it enters its seventh decade, are the mounting cost of new technology and medicines, and an aging population.