Britons missed more cancer screenings and face lower cancer survival rates due to the U.K. National Health Service’s handling of COVID-19, a new study reports.
All health systems had to change and adapt due to the pandemic, but countries with single-payer health insurance, such as the United Kingdom, had a more difficult time managing medical issues alongside COVID-19.
In a study published in The Lancet on July 20, 2020, researchers evaluated the effects of the National Health Service (NHS) suspending cancer screening, deferring routine diagnostic work, and prioritizing urgent symptomatic cases for intervention in response to the COVID-19 lockdown that began in the United Kingdom in March 2020. The researchers concluded that “substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the U.K.”
Waitlists, Backlogs, and Delays
Waiting lists and backlogs to health care in single-payer systems can explain the anticipated decline in cancer survival rates, says Sally Pipes, president, CEO and health policy fellow at the Pacific Research Institute and policy advisor to The Heartland Institute, which co-publishes Health Care News.
“In the U.K., under COVID-19, the NHS has predicted that lack of timely and proper treatment is expected to result in an extra 50,000 cancer deaths,” Pipes said. “They predict that the NHS waiting list is expected to top 10 million by the end of the year. One in eight Brits is in a queue. Waits are expected to grow even longer under the pandemic. Every month, some 400,000 procedures are getting backlogged in the U.K.”
Backlogs are not unique to the NHS but have been a problem in other countries with single-payer health insurance, Pipes says, after predicting such an outcome in March.
“In Canada, the Canadian health authorities reported 100,000 procedures have been delayed or canceled because of COVID-19,” Pipes said. “There are so many stories of delayed and denied care pre-COVID. Now the lines are even longer. The average Canadian, last year waited on average 20.9 weeks between seeing a primary care doctor to getting treatment by a specialist. And it is not free—this year the average Canadian family of four will pay $14,474 in hidden taxes for this rationed care.”
One reason for the backlogs and delays is that in systems like the NHS, the government controls how much is spent on healthcare, Pipes says.
“When government is in charge, officials determine how much of GDP will be spent on health care,” Pipes said. “The U.S. spends about 18 percent on health care whereas Canada spends just over 11 percent. In these countries, the demand is always greater than government is willing to spend. As a result, there are long waiting lists, rationed care, and doctor shortages. Under a pandemic such as COVID-19, the stress on an already strained system results in even longer waits.”
Single-Payer Money Crunch
The cost of care continues to weigh heavily on the NHS system, and the COVID-19 pandemic is exposing its funding issues. In mid-July 2020, NHS received a 3-billion-pound funding boost, but concerns remain over whether there will be enough funds to efficiently clear the huge patient backlogs. The effects of the underfunding remain to be seen, says Avik Roy, president of The Foundation for Research on Equal Opportunity (FREOPP).
“It’s too early to tell how the response by NHS will impact the health of British citizens, or how it will affect their confidence in the NHS,” Roy told Health Care News. “The NHS’s biggest problem is its fiscal sustainability (ranking 25th on that measure in the World Index of Healthcare Innovation). Chronic underfunding will lead to lower quality and poorer access to care.”
The underfunding may cause a more significant problem in the United Kingdom, a serious recession compared to other developed nations, Roy explains.
“And now, the Organization for Economic Cooperation and Development is predicting that the U.K. faces the worst recession in all of the developed nations,” Roy said. “In FREOPP’s World Index of Health Care Innovation, we found that the U.K. health system’s fiscal sustainability ranked 25th of 31. This is due to the country’s high debt-to-GDP ratio and its high public health spending per capita.”
The COVID-19 pandemic, combined with a serious recession, may lead to some serious changes in publicly funding insurance in the United Kingdom.
“While COVID treatment may be available to all U.K. citizens, the publicly funded insurance and hospital system will not be fiscally sustainable in its current form much longer,” Roy said.
Camille Maringe, PhD., James Spicer, PhD., Melanie Morris, PhD., Arnie Purushotham, M.D., Ellen Nolte, PhD, Richard Sullivan, PhD., et at., “The Impact of the Covid-19 Pandemic on Cancer Deaths Due to Delays in Diagnosis in England, UK: A National, Population-based Modelling Study, The Lancet, July 20, 2020: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30388-0/fulltext