United Kingdom

The United Kingdom of Great Britain and Northern Ireland is made up of four countries: England, Scotland, Wales, and Northern Ireland. There are also 14 overseas territories under the jurisdiction of the United Kingdom. For the purposes of reviewing health-care systems, the terms United Kingdom and England are used interchangeably in this article, unless otherwise stated.

Before World War II, some British political leaders had already expressed significant concerns about the lack of quality affordable healthcare for the poorer segment of the population. Not long after the war ended, on July 5, 1948, the Minister of Health, Aneurin (aka Nye) Bevan of the Labour Party, established the National Heath System (NHS), one of the first comprehensive healthcare systems created worldwide; advocates believed that not only would this help solve the healthcare problem, but that it was also an important step in rebuilding Britain after World War II. From its inception, the NHS was to be—and has been—funded almost entirely from a taxation system, wherein the rate paid was based upon a person's income. Moreover, anyone living in England, even if temporarily, was able to receive its benefits, even if the person had not paid into the healthcare system; visitors would also be eligible.

The NHS is still the core of the healthcare system in the United Kingdom, although it has undergone two major reforms. Scotland and Wales also use the term National Health System for their healthcare systems, while Northern Ireland uses the term Health and Care, North Ireland.

In England, the NHS is controlled by the Department of Health. Reporting directly to the Department of Health are 10 Strategic Health Authorities, organized by region. The Strategic Health Authorities, in turn, supervise the Primary Care Trusts, which oversee most of the NHS's budget and are responsible for the healthcare services provided to people living in the country.

Although, in 1948, members of both political par-ties—Labour and Conservative—most likely would have agreed that the current healthcare system did not equitably serve all of their constituents, and although millions of citizens of the era struggled to receive healthcare services, the NHS was not universally well received. Both the Conservative Party and the British Medical Association (BMA) strongly spoke out against the system. Political criticisms often stated that Nye was leading Britain into a socialist system, similar to one that had existed under Adolph Hitler, who had been a main catalyst of the horrific war just fought.

Members of the BMA worried that they would lose their independence as physicians, along with their ability to buy and sell practices, and they expressed concern that their incomes would severely drop. When the NHS initially became the official health-care system of the United Kingdom, members of the BMA refused to cooperate or negotiate details with the government. For two years, debate was significant; a partial breakthrough was achieved when Bevan allowed members of the BMA to treat patients within the NHS and still treat private patients. On the two-year anniversary of the NHS, 90 percent of the BMA physicians were operating within the system. Ultimately, though, the members did lose their ability to buy and sell medical practices.

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