OBJECTIVE To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. SETTING Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. MAIN OUTCOME MEASURES 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. RESULTS The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. CONCLUSIONS The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.

中文翻译：

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与其他高收入国家相比，英国国家卫生服务局的绩效：观察性研究。

目的要确定英国国家卫生服务局（NHS）相对于其他高收入国家的卫生系统的表现如何，因为该国正面临持续的资金压力，需求水平的提高以及社会福利的削减。设计观察性研究使用了来自主要国际组织（例如，欧盟统计局和经济合作与发展组织）的辅助数据。设置英国和9个高收入比较国家/地区的医疗保健系统：澳大利亚，加拿大，丹麦，法国，德国，荷兰，瑞典，瑞士和美国。主要观察指标79指标涵盖七个领域：人口和医疗保健覆盖率，医疗保健和社会支出，结构能力，利用率，获得医疗服务，护理质量和人口健康。结果与所有其他研究国家相比，2017年英国在人均医疗保健上的支出最少（英国$ 3825（£2972;€3392）;平均$ 5700），支出增长略低（英国国内生产总值的0.02％）。前四年的平均值为0.07％）。尽管使用率（住院人数）平均，但英国的未满足需求率最低，人均医生和护士人数也最少。英国的平均预期寿命（81.3岁，平均为81.7岁）略低于平均寿命，癌症生存率包括乳腺癌，宫颈癌，结肠癌和直肠癌。尽管一些卫生服务的结果很差，例如腹部手术后的败血症（每10万次出院2454英磅；每10万次出院平均2058英磅），急性心肌梗死（联合王国7.1％；平均5.5％）和缺血性卒中（联合王国9.6％；平均6.6％）的30天死亡率，联合手术后，英国的术后深静脉血栓形成率低于平均水平，医疗相关感染较少。结论NHS表现出良好的表现，包括在医疗服务方面的表现，但支出，患者安全性和人群健康至多都低于平均水平。综上所述，这些结果表明，如果NHS希望在人口压力不断增加的情况下取得可比的健康结果，则可能需要花费更多的钱来增加劳动力和长期护理的供应，并减少社会支出的下降趋势以适应比较国家的水平。英国在联合手术后获得的术后深静脉血栓形成率低于平均水平，并且与医疗相关的感染也较少。结论NHS表现出良好的表现，包括在医疗服务方面的表现，但支出，患者安全性和人群健康至多都低于平均水平。综上所述，这些结果表明，如果NHS希望在人口压力不断增加的情况下取得可比的健康结果，则可能需要花费更多的钱来增加劳动力和长期护理的供应，并减少社会支出的下降趋势以适应比较国家的水平。英国在联合手术后获得的术后深静脉血栓形成率低于平均水平，医疗相关感染也更少。结论NHS表现出良好的表现，包括在医疗服务方面的表现，但支出，患者安全性和人群健康至多都低于平均水平。综上所述，这些结果表明，如果NHS希望在人口压力不断增加的情况下取得可比的健康结果，则可能需要花费更多的钱来增加劳动力和长期护理的供应，并减少社会支出的下降趋势以与之相称。比较国家的水平。但是支出，患者安全性和人群健康状况全都低于平均水平。综上所述，这些结果表明，如果NHS希望在人口压力不断增加的情况下取得可比的健康结果，则可能需要花费更多的钱来增加劳动力和长期护理的供应，并减少社会支出的下降趋势以适应比较国家的水平。但是支出，患者安全性和人群健康状况全都低于平均水平。综上所述，这些结果表明，如果NHS希望在人口压力不断增加的情况下取得可比的健康结果，则可能需要花费更多的钱来增加劳动力和长期护理的供应，并减少社会支出的下降趋势以与之相称。比较国家的水平。