Top 5 Things Americans Need to Know About the the UK’s Healthcare System- the NHS

Many Americans are drawn to the UK for its universal healthcare. Here are 5 important things you need to know about England’s Healthcare System.

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1. Is England’s healthcare system really free?

The The National Health Service (NHS) was born in July of 1948, entitling all ordinary residents to free public healthcare. All hospital, physician, maternity, community-based care, assistive devices, and mental health services are free at the point of delivery.

The NHS Constitution of England states that services are provided based on clinical need, not an individuals ability to pay.

You will never receive a bill or be asked to pay for services. This is not dependent on income or employment status.

The NHS is funded through taxpayer dollars, with the average Brit paying 18%-35% of their wages, depending on their income level.

Because the England’s healthcare system belongs to the people, it has a stated commitment to “providing the most effective, fair, and sustainable use of its finite resources”. If you have a new issue, your doctor may be less likely to immediately order extensive testing and lab work, although you have a right to all necessary testing and treatment.

It’s unlikely that your physician would immediately order an MRI because you come in with back pain, as is often the case in the United States. You may even need to present evidence as to why you think a certain test or treatment is necessary.

While some visitors are entitled to free healthcare in the UK, not everyone who enters the UK on a visa is considered an “ordinary resident”. You can use the Home Office’s Ordinary Resident Tool to determine your status.

Depending on what visa you use to enter England, you may also need to pay an annual NHS surcharge in addition to the amount you will pay in taxes.

Healthcare is not tied to your job. If you leave your job, take time off, go on sick leave, or decide to open your own business, you will not lose coverage.

In fact, it’s not uncommon for UK citizens to take a break from their jobs during their careers to travel or take care of a family member. This is made possible by universal healthcare and flexible working policies.

2. How much will I pay for my prescriptions?

Prescriptions are free for some people, including those over 60 and under 16, students between 16 and 18, new mothers, patients that have a listed medical condition, and in certain other circumstances.

The cost of outpatient prescriptions is currently capped at £9.65. Even prescriptions that come with eye-watering price tags in the United States are £10 or less in the UK. This can make a significant difference in the lives of British residents, especially the 277,000 who rely on insulin.

Even some drugs that have price tags over $1,000,000 per dose in the United States are available to British residents due to negotiations between the NHS and certain drug companies.

When compared with the US, British citizens spend far less on medications.

Although prescriptions are cheaper, fewer new drugs are being approved in post-Brexit UK when compared with the US. Patients in the US also have more flexible access to many drugs, although they will pay more for it.

The UK’s National Institute for Health and Care Excellence is working to decrease the time it takes for new drugs to be approved, which should provider faster access in the future.

3. What is the quality of England’s healthcare system?

In 2021, the NHS lost its rating as the best healthcare system in the world. In 2022, the U.S. New and Word Report ranked the UK #7 out of 10 for Countries with the Best Public Health Care Systems.

Another recent comparison of global health systems placed the UK second to last in health care outcomes, including life expectancy and survival rates.

You may find you have to endure longer wait times for care. There is growing frustration at the length of time Brits are waiting to access care, although this is not always the case.

Access to care can also differ greatly from one area to another, an inequity referred to as the “post code lottery“.

Although the national target is under 4 hours, a recent article showed 1 in 10 Brits are waiting over 12 hours to be seen in an emergency room.

In 2023, the national average for ambulance wait times for even the most serious concerns, such as heart attack and stroke, was 1hr 32m 54s. The target response time is 18 minutes.

(You can check wait times on the NHS My Planned Care page.)

4. Is maternity care covered?

Maternity, (or antenatal) care, is not only free to ordinary residents in England, it may be safer than having a baby in the US.

If you came from abroad, you may or may not be considered an ordinary resident. While you will not be refused care, you may be billed fees for any maternity services you receive.

As of 2021, the minimum non-residents can expect to be charged for maternity care is £7000. You can use this worksheet to check if you would be considered an ordinary resident with the right to free maternity care.

Women who are legally employed in England are also entitled to 52 weeks of maternity leave, with 90% of their pay for the first 33 weeks.

5. How can I check the quality of the healthcare in a specific area?

The Care Quality Commission is the independent regulator for health and social care in England. They regularly perform on-sight inspections and issue reports and ratings ranging from outstanding to inadequate.

To look for reports for a specific practice or hospital in a specific area, search on their website. You can see ratings and also read full reports with detailed information on different quality measures.

What’s the future of England’s healthcare system?

The NHS has been called the closest thing the English have to a national religion. It is a source of national pride.

However, many Brits across the political spectrum feel that the NHS is at a breaking point and in the worst state ever seen in its 75-year history. Staffing shortages along with frequent physician strikes are compounding the stress on their treasured system.

There is a lot of disagreement about how to fix the NHS with many Brits strongly opposed to privatization and others feeling it is the only way forward.

Despite the long wait times for access to care, the British continue to express a deep sense of gratitude and appreciation for the NHS and its staff.

My Personal Experience Using England’s Healthcare System

After carefully researching our move to England, we decided to live in York because of its access to good healthcare, excellent schools, and high safety ratings. After living in England for the last year, every member of my family has now used the NHS.

We have found the staff to be caring, competent, and thorough. On most occasions, we have been able to access care within the same timeframe that I would expect in the US.

I pay less than £10 a month for the only prescription I take, which was $100 dollar a month in the US.

On the other hand, I waited weeks for a referral to get an ultrasound and eventually ended up paying £249 to have it done privately.

Several months later I began having back pain and wanted to see a physiotherapist. I waited 6 weeks to get a call back from my doctor for a referral (most people can self-refer for a physiotherapist), and by that time the pain had resolved.

I still wanted to be seen to avoid any issues in the future, but was told physiotherapy would not by covered unless I was currently having pain. I could have paid to see someone privately, but I decided it wasn’t worth the cost at that time.

On the other hand, we have had a number of visits with specialists and received diagnostic treatment such as mammograms and x-rays, all free of charge.

It can be hard for Americans to imagine walking into a hospital for care without having to think of the cost. But the British can’t understand how we cope with the added stress of a bill when going through a health challenge.

These are 5 things you should know about England’s healthcare system before you move. If you have additional questions, please leave them in the comments!