英国伦敦政治经济学院Irene Papanicolas研究团队，将英国国民健康服务与其他高收入国家进行了比较。该项研究成果在线发表于11月27日的《英国医学杂志》。

为了了解英国国民健康服务体系（NHS）在面临持续的财政压力、不断增长的需求和社会保障削减的情况下，与其他高收入国家相比表现如何，研究组对英国和九个高收入国家的医疗体系进行了比较，包括澳大利亚、加拿大，丹麦，法国，德国，荷兰，瑞典，瑞士和美国。

与其他九国相比，2017年英国人均医疗支出最低，为3825美元，而十国的平均值为5700美元，且支出增速略低，前四年占GDP的0.02%，而十国均值为0.07%。英国的未满足需求率最低，人均医生和护士人数也最低，尽管其利用率（住院人数）处于平均水平。

英国的平均预期寿命为81.3岁，略低于平均值81.7岁，癌症生存率也略低于平均水平，包括乳腺癌、宫颈癌、结肠癌和直肠癌等。英国的一些健康服务效果较差，例如腹部手术后的败血症发生率为2454/100000术次，而十国均值为2058/100000术次；急性心肌梗死和缺血性卒中的30天死亡率分别为7.1%和9.6%，而十国均值分别为5.5%和6.6%。英国的关节术后深静脉血栓形成致死和医疗相关感染的发生率均低于十国的平均水平。

总之，英国NHS在医疗服务效果等方面表现良好，但在医疗支出、患者安全、人群健康等方面要低于平均水平。分析结果表明，若NHS希望在人口压力日益增长的情况下获得较好的健康效果，可能需要增加开支，以扩充人力，提供长期护理、减少社会支出的下降趋势，从而赶上其他九国的平均水平。

附：英文原文

Title: Performance of UK National Health Service compared with other high income countries: observational study

Author: Irene Papanicolas, Elias Mossialos, Anders Gundersen, Liana Woskie, Ashish K Jha

Issue&Volume: 2019/11/27

Abstract: 

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.

DOI: 10.1136/bmj.l6326

Source: https://www.bmj.com/content/367/bmj.l6326