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Healthcare Market Review 2005
Key Note Publications Ltd, Sep 2005
This 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). It is estimated 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.
It is estimated 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: HCHS, which are responsible for hospital-based services; and FHS, which are responsible for frontline community-based primary care. HCHS account for the bulk of NHS expenditure. Within FHS, the highest proportion of expenditure is on pharmaceutical services (PHS).
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, we estimate 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.
Healthcare services in the UK are under increasing pressure from a demographically ageing population. In addition, medicine is a technology-driven market, with new treatments and procedures continually expanding the scope of care. The Government has been trying to contain costs and improve efficiency in the public sector through significant increases in funding, coupled with the use of increasingly tough targets. In addition, the Government has recently been introducing reforms aimed at the decentralisation of decision making, and the reduction of bureaucracy and administrative costs.
The private sector has responded to funding pressures and the drive for cost efficiency by adding value to services, which broadens the scope of these services. The result has been a significant rise in acquisition and merger activities within the private sector, creating large companies that operate across the continuum of healthcare, with greater flexibility and economies of scale. At the other end of the spectrum, conditions have become increasingly difficult for small, independent operators.
Although the problems facing healthcare in the UK are complex, intractable and significant, there is immense political and public will for great improvements in the delivery of healthcare in the UK. The stakes are particularly high for a government that has been pouring unprecedented amounts of funding into the health sector, and for a public that are still looking for significant signs of improvement.
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