The UK’s health system has been under pressure to manage costs whilst still delivering a reliable service. Despite this, Ben Hargreaves finds that overall healthcare expenditure in the UK has fallen for the last two years due to a drop in government spending.

英国卫生系统一直面临着管理成本的压力，同时仍在提供可靠的服务。尽管如此，本·哈格里夫斯（BenHargreaves）发现，由于政府支出的下降，英国的整体医疗支出在过去两年中有所下降。

The UK is struggling with its healthcare expenditure. The challenge facing the country is how to make healthcare more efficient, but also ensure enough is being invested to ensure the quality does not suffer. As of 2023, the country spends 10.9% of its GDP on healthcare, more than double the percentage seen in 2000.

英国在医疗保健支出方面举步维艰。该国面临的挑战是如何提高医疗保健的效率，同时确保投入足够的资金以确保质量不受影响。截至2023年，该国将其GDP的10.9%用于医疗保健，是2000年的两倍多。

However, greater spending on healthcare is not specific to the UK – government healthcare expenditure across many high-income countries has accelerated over the last few decades. The factors in common are similar across these nations: ageing populations, higher rates of chronic disease, and greater prevalence of public health issues, such as obesity..

然而，增加医疗保健支出并不是英国特有的——过去几十年来，许多高收入国家的政府医疗保健支出都在加速增长。这些国家的共同因素是相似的：人口老龄化，慢性病发病率较高，以及肥胖等公共卫生问题的普遍存在。。

Unlike a number of other nations, the UK’s NHS is a single-payer healthcare system. This offers unique advantages for the public, but also raises difficult questions about funding and sustainability. In a recent publication by the UK’s Office for National Statistics (ONS), it was revealed that total healthcare expenditure, which is comprised of the spending of the government, private individuals, and non-government entities, had decreased in 2023 by 1.4%, after adjusting for inflation.

与其他许多国家不同，英国的NHS是一个单一付款人的医疗保健系统。这为公众提供了独特的优势，但也引发了资金和可持续性的难题。英国国家统计局（ONS）最近发布的一份出版物显示，2023年，经通货膨胀调整后，由政府、私人和非政府实体支出组成的医疗保健总支出下降了1.4%。

Given that 84% of respondents to a recent survey consider the NHS, a major component of healthcare expenditure, to have a major or severe funding problem, the figures warrant a deeper examination..

鉴于最近一项调查中84%的受访者认为NHS（医疗保健支出的主要组成部分）存在重大或严重的资金问题，因此需要对这些数字进行更深入的研究。。

Cutting costs or cutting corners

削减成本或偷工减料

The ONS report revealed top-line findings from its data showing that UK healthcare expenditure was approximately £292 billion in 2023, with government-financed healthcare expenditure representing around £239 billion of this figure. On the latter, this represented a real terms decrease of 2.1% in spending on the part of the government.

国家统计局的报告显示，其数据显示，2023年英国医疗保健支出约为2920亿英镑，其中政府资助的医疗保健支出约为2390亿英镑。就后者而言，这意味着政府支出实际下降了2.1%。

Specific to the pharmaceutical industry, the data showed that total pharmaceutical spending was reduced by 16.6% in real terms, though this mainly reflects lower spending on COVID-19 vaccinations..

。。

The UK’s healthcare expenditure in 2023 was noted to be the second consecutive year that had seen a fall, after a 4% decrease in 2022. A caveat was added that this real terms drop, adjusted for inflation, is estimated through a GDP deflator that uses general inflation as its marker, which may differ from the inflation seen with health-specific goods and services.

。有人补充说，经通货膨胀调整后的实际价格下降是通过GDP平减指数估算的，该指数以一般通货膨胀为标志，这可能不同于特定于健康的商品和服务的通货膨胀。

In terms of healthcare expenditure as a share of GDP, the figure of 10.9% represents a reduction from 11.1% in 2022, though this is higher than the period (2009-2019) preceding the pandemic, where expenditure lay between 9.6% and 10%..

就医疗保健支出占国内生产总值的比例而言，10.9%的数字比2022年的11.1%有所下降，尽管这高于大流行之前的时期（2009-2019年），该时期的支出在9.6%至10%之间。。

Overall, the ONS attributed the fall in healthcare expenditure in 2023 to have been caused by lower government spending, with non-government financing growing overall in real terms. In a statement on the publication of the figures, Avinash Hari Narayanan, clinical lead at London Medical Laboratory, said: “With real-term cuts in government funding, private health spending – particularly on preventative health products – looks increasingly sensible.

总的来说，国家统计局将2023年医疗支出的下降归因于政府支出的减少，非政府融资总体上实际增长。伦敦医学实验室（London Medical Laboratory）临床负责人阿维纳什·哈里·纳拉亚南（Avinash Hari Narayanan）在一份关于公布这些数字的声明中表示：“随着政府资金的实际削减，私人医疗支出，特别是预防性保健产品的支出，看起来越来越合理。

The fact that consumers are spending money on preventative healthcare items such as vitamins, supplements, and off-the-shelf blood tests looks to be a prudent decision in the face of a reduction in government health spending as a share of GDP.”.

面对政府医疗支出占GDP的比例下降，消费者将钱花在预防性医疗保健项目上，如维生素、补充剂和现成的血液检测，这似乎是一个谨慎的决定。”。

The ONS noted that the figures released in its report are to be considered preliminary, due to being based on initial data taken from its sources and stated that the findings are subject “to a greater degree of uncertainty” than expenditure published between 1997 and 2022.

国家统计局指出，其报告中公布的数字将被视为初步数字，因为这些数字是基于从其来源获得的初步数据，并表示调查结果比1997年至2022年期间公布的支出“具有更大程度的不确定性”。

Counting pennies

数硬币

The Institute for Fiscal Studies (IFS) released its report, just prior to the ONS’ figures, in which the research institute looked into how healthcare spending has changed over the last seven decades. The institute found that in real terms, over the course of the current parliament (2019-2024), UK government health spending has grown below the long-term average, with a figure of 2.4% against the average of 3.6%.

就在国家统计局公布数据之前，财政研究所（IFS）发布了一份报告，该研究所调查了过去70年来医疗保健支出的变化。该研究所发现，在本届议会（2019-2024年）期间，英国政府卫生支出的实际增长率低于长期平均水平，分别为2.4%和3.6%。

In terms of budget, the Department of Health and Social (DHSC)’s grew by less than planned over this parliament, with ‘cash top-ups’ insufficient to offset the effects of higher inflation..

在预算方面，卫生和社会部（DHSC）在本届议会期间的增长低于计划，“现金补充”不足以抵消通货膨胀的影响。。

The Conservative Party’s initial plans at the 2019 general election were for a rise in the day-to-day budget of 3.3% per year in real terms. The IFS noted that the party’s current plans would imply an average growth of 2.7% per year between 2019 and 2025.

保守党在2019年大选中的初步计划是将日常预算实际每年提高3.3%。国际单项体育联合会指出，该党目前的计划意味着2019年至2025年期间每年平均增长2.7%。

Further, the institute outlined that capital spending in 2023-2024 had been ‘raided’ to fund day-to-day healthcare services. Capital spending represents approximately 5% of total government healthcare expenditure and is the budget responsible for investment in fixed assets, such as hospital buildings and medical equipment.

此外，该研究所概述，2023-2024年的资本支出被“突击”用于资助日常医疗服务。资本支出约占政府医疗保健支出总额的5%，是负责固定资产投资的预算，如医院建筑和医疗设备。

By the government’s spending control framework, this budget should not be available to finance day-to-day budgets. However, the IFS found that almost £1 billion had been transferred from the capital to the resource budget to meet in-year spending pressures..

根据政府的支出控制框架，该预算不应用于资助日常预算。然而，国际单项体育联合会发现，近10亿英镑已从资本转移到资源预算中，以应对年内的支出压力。。

In a broader analysis, the institute found that capital expenditure in the UK is below the average for advanced economies. As a result, it noted that the country’s capital spending has been “insufficient to maintain the quality of the physical NHS estate,” increasing the estimated maintenance backlog.

在更广泛的分析中，该研究所发现英国的资本支出低于发达经济体的平均水平。因此，它指出，该国的资本支出“不足以维持NHS实体房地产的质量”，增加了预计的维护积压。

To carry out repairs and replacements, the cost of the backlog of work required has more than doubled between 2013-2014 (£5.4 billion) and 2022-2023 (£12.5 billion)..

为了进行维修和更换，在2013-2014年（54亿英镑）和2022-2023年（125亿英镑）之间，所需积压工作的成本翻了一番以上。。

Playing politics

玩弄政治

In reaction to the financial pressures placed on healthcare spending, particularly in relation to the NHS, the IFS concluded: “In the face of demographic and other cost pressures, spending will need to rise just for the service to stand still. And even standing still would leave the NHS performing considerably worse than it was pre-pandemic, despite some recent progress in cutting the overall waiting list..

针对医疗保健支出面临的财务压力，特别是与NHS相关的财务压力，国际单项体育联合会得出结论：“面对人口和其他成本压力，支出需要增加，才能使服务保持静止。即使静止不动，NHS的表现也会比大流行前差得多，尽管最近在削减总体等待名单方面取得了一些进展。。

“The NHS workforce plan – which both the Conservative and Labour parties have committed to – is, in effect, a recognition of this, and implies substantial real terms funding increases over time. Such increases though will inevitably force hard fiscal decisions to be made elsewhere – decisions that all political parties are keen to postpone until after the general election.”.

“保守党和工党都承诺实施的NHS劳动力计划实际上是对这一点的认可，意味着随着时间的推移，实际资金会大幅增加。尽管如此，这种增加将不可避免地迫使其他地方做出艰难的财政决定，所有政党都希望推迟到大选后再做出决定。”。

As the date of the UK general election nears, the parties will face increased pressure from all angles to deliver increased spending on healthcare. According to Ipsos, 61% of UK citizens would support higher taxes if it meant more funding was provided to the NHS. While the pharma industry is calling for greater public spending on R&D in the country and more funding for new therapies.

随着英国大选日期的临近，各方将面临来自各个角度的压力，要求增加医疗保健支出。根据Ipsos的数据，如果这意味着向NHS提供更多资金，61%的英国公民将支持提高税收。。

Until the election is held, there will remain uncertainty over the direction of spending on healthcare, though it is likely to be a major talking point in the debate leading up to election day..

在选举举行之前，医疗保健支出的方向仍将存在不确定性，尽管这可能是选举日前辩论中的一个主要话题。。