ANALYSIS
Fig 3 | Per capita spending on all financing schemes, OECD countries (2019 and 2022, $, purchasing power parities) 3
Such international comparisons show that higher, and lower, healthcare spending is certainly possible, but taking account of factors known to influence spending levels — for example, and for
illustrative purposes, countries ’ wealth as measured by GDP, the UK ’ s healthcare spending is slightly higher than expected given its per capita GDP (fig 4).
Fig 4 | Relation between per capita gross domestic product (GDP) and per capita healthcare spending. OECD countries, 2022 ($, purchasing power parities (PPP)) 3 The regression trend line excludes three outlier countries: the US, Luxembourg, and Ireland. The last two are unusual owing to the nature of the sources of their GDP (eg, businesses registered in these countries for tax purposes and hence contributing to GDP but with minimal impact on population size and hence health spend) and the first has unusual levels of health spend associated with high inefficiencies in its production of healthcare. Inclusion of these countries weakens the relation between per capita GDP and health spend (R 2 =0.43) but does not materially change the UK ’ s position relative to its expected spend on healthcare given its GDP
A further approach is simply to use history as a guide, projecting forward historical spending growth. On this basis, as figure 5 shows, by around 2058 the share of GDP devoted to the NHS will double to 16.5%. By 2070 more than a fifth (21%) of the economy would be spent, and by the end of the century this would reach 36%. Increasing the rate of real growth in NHS spending to 4% from 2023-24 would mean that around 85% of UK GDP would be
consumed by the end of the century. To put these figures in context, a doubling of the proportion of GDP spent on the NHS would, all things being equal, lead to a doubling of actual resources used by the NHS, not least labour, which could see its share of the working population also double, from around one in 17 now, to one in eight in2058.
the bmj | BMJ 2024;384:e079341 | doi: 10.1136/bmj-2024-079341
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