International comparisons of health care quality: How good is the NHS?

An analysis of 22 indicators of care quality across 18 countries to explore how the UK compares against health systems in other developed countries.


Published: 25/06/2018

ISBN: 978 1 910953 50 1

Download the report [PDF 3.1MB]

In this extensive report, the Nuffield Trust, the Health Foundation, The King’s Fund and the Institute for Fiscal Studies have joined forces to assess, using a range of metrics, how health system performance in the UK compares internationally with 18 other broadly similar countries: the USA, Germany, Sweden, France, Japan, Canada, Netherlands, Belgium, Denmark, Austria, Australia, Finland, New Zealand, Spain, Portugal, Italy, Greece and Ireland. 

The research uses OECD data and a range of other public sources to provide an international context to what we might mean by a good health care system: the speed and accessibility of care, the efficiency of the system, and the outcomes delivered for patients. It also sets the scene by looking at what the UK health service has to work with, so that we can consider whether it is doing a good job given the circumstances.

The report finds that the NHS performs neither as well as its supporters sometimes claim nor as badly as its critics often allege. Compared with health systems in similar countries, it has some significant strengths but also some notable weaknesses.

Key strengths of the UK’s NHS include:

  • It provides unusually good financial protection to the public from the consequences of ill health. For example, it has the lowest proportion of people who skipped medicine due to cost (2.3% in 2016 compared to an average of 7.2% across the comparator countries)
  • It is relatively efficient: the UK has the largest share of generic prescribing of all comparator countries, at 84% in 2015 compared to an average of 50%
  • It performs well in managing patients with some long-term conditions like diabetes and kidney diseases: fewer than one in a thousand people are admitted to hospital for diabetes in a given year, compared to over two in a thousand admitted in Austria or Germany.

Key weaknesses include:

  • The UK’s NHS performs worse than the average in the treatment of eight out of the 12 most common causes of death, including deaths within 30 days of having a heart attack and within five years of being diagnosed with breast cancer, rectal cancer, colon cancer, pancreatic cancer and lung cancer, despite narrowing the gap in recent years
  • It is the third-poorest performer compared to the 18 developed countries on the overall rate at which people die when successful medical care could have saved their lives (known as ‘amenable mortality’)
  • It has consistently higher rates of death for babies at birth or just after (perinatal mortality), and in the month after birth (neonatal mortality): seven in 1,000 babies died at birth or in the week afterwards in the UK in 2016, compared to an average of 5.5 across the comparator countries.

Given limited or patchy data in certain areas and the inherent complexity of making comparisons internationally, this analysis does not provide us with the final word, but rather a set of issues to address as we look forward from the health service’s 70th birthday in how a national discussion about how government, society and the public can work with the NHS to realise this goal more successfully than ever.

This report was originally produced to mark the BBC's coverage of the NHS's 70th birthday in July 2018 which saw researchers from the Health Foundation, the Institute for Fiscal Studies, The King’s Fund and the Nuffield Trust join forces for the first time, using combined expertise to shed light on some of the big questions on the NHS. This report was the first of five reports in the series.

A similar report was produced in 2015 comparing 14 countries on 27 care quality indictors which is available here.


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Suggested citation

Dayan M, Gardner T, Kelly E and Ward D (2018) How good is the NHS? Nuffield Trust.