Analyzing the Changing Role of the Physician in the USA/UK Health Care Systems

Author: John Tooker
Submitted: Friday 4th of November 2011 03:34:48 PM
Submitted by: egf
Educational levels: expert, qc2, qc3


Influenced strongly by their respective national politics and the real threat of rising health care costs, the health care systems of the United Kingdom (UK) and the United States (US) are simultaneously undergoing systemic change, and within those systems the roles of physicians are expected to change. The rationales to reform health care delivery in both countries are similar: to lower the overall costs of health care in the face of increasing demand for services, while improving the quality of care delivered. The UK Conservative coalition (Conservatives and Liberal Democrats) government led by David Cameron, the Prime Minister, came to power in May of last year with reform of the National Health Service (NHS) as one of the Conservative Party’s campaign goals. Two months after the elections (July of 2010), the Department of Health published a plan2 to reform the English branch of the NHS. The reform plan, as originally published, dramatically increases the role of General Practitioners (GPs) within the NHS. While continuing to provide comprehensive primary care to their patients, the NHS GPs would also take on the responsibility and the risk of purchasing all the health services required for their patients, including general hospital services. The “reform” plan has, since published, met strong professional and political opposition - not unlike the US reform plan – and is undergoing change through a series of amendments in both houses of parliament. Health care reform in the US has gone down a similar path. Faced by unsustainable costs and unacceptable population health and health care quality, the Democratic administration of President Barack Obama and the US Congress enacted legislation - the Recovery and Reinvestment Act of 2009 (ARRA) and the Patient Protection and Affordable Care Act (PPACA or ACA – 2010) - to fulfil the vision of the “triple aim”, promulgated and popularized by Dr. Don Berwick and colleagues. Dr. Berwick is the current Administrator for the US Center for Medicare and Medicaid Services (CMS), a very large federal agency responsible for the federal insurance program for the elderly (Medicare) and the federal and state insurance program for children and the poor (Medicaid). The three aims are: “improving the experience of care, improving the health of populations, and reducing per capita costs of health care”5 Similar to the UK, physicians in the US, if the PPACA is fully implemented, will be required to organize into collective units - the working model is the “accountable care organization (ACO)” – which will be responsible for the comprehensive delivery of care in both the ambulatory and hospital settings, meeting evidence-based quality standards, utilizing health information technology and staying within a budget. Gain-sharing will likely be a financial incentive to improve both the quality and efficiency of health care delivery. This presentation will analyze, compare and contrast the changing roles of physicians in the USA and UK. Although reforms will vary according to local norms, the rationale for reform on both sides of the Atlantic is the same and global, – how best to make affordable and high quality health care available to everyone. References: 1. Timmons, N. Letter From Britain: Across The Pond, Giant New Waves Of Health Reform Health Affairs, 29, no.12 (2010):2138-2141 2. Department of Health (UK). Equity and Excellence: Liberating the NHS [Internet]. London: The Department; 2010 Jul 12 [cited 2011 Aug 16]. Available from: 3. Department of Health (UK) Liberating the NHS [Internet]: Legislative Framework and Next Steps. London: The Department; 2010 Dec 15 [cited 2011 Aug 17] Available from: 4. Timmons, N. Remaking England's National Health Service? Not So Fast Health Affairs, 30, no.8 (2011):1399-1401 5. Berwick, DM, Nolan, TW, and Whittington, D. The Triple Aim: Care, Health, And Cost, Health Affairs, 27, no.3 (2008):759-769 6. McDonough, John E. Inside National Health Reform Berkeley: University of California Press and New York: Milbank Memorial Fund, 2011 (this book is available in hardcopy, and on e-readers: Kindle, Nook and Nook application for iPad) 7. “About the Law”; (Comprehensive US Government website about the health care reform law) 8. Health Reform Source, Henry J. Kaiser Family Foundation. “The Basics” (Comprehensive foundation website about the health care reform law)


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John Tooker. Analyzing the Changing Role of the Physician in the USA/UK Health Care Systems. EUROGENE portal. November 2011. online:

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