Updated estimates for total healthcare expenditure in the UK between 1997 and 2012. Estimates are also given for total expenditure on healthcare in the UK per capita, current and capital expenditure and public and private expenditure on healthcare in the UK and healthcare expenditure in the UK as a share of gross domestic product (GDP). International comparisons of total healthcare expenditure as a share of GDP are made with the G7 countries and the volume consumption of private healthcare expenditure is compared to other household consumption trends based on classification of individual consumption by purpose (COICOP; ESA 95) definition. All expenditure figures are consistent with international definitions provided by the Organisation for Economic Co-operation and Development (OECD, 2011a and OECD, 2000) and presented in current price terms. OECD uses this data to publish international comparisons.
Total expenditure on healthcare in 2012 was £144.5bn. Healthcare expenditure growth was strong between 1997 and 2009 with an average annual growth rate of 8.0%. Since 2009 growth rates have slowed significantly to an average of 1.6%.
Private healthcare expenditure fell by -1.4% in 2012 as compared to 2011, while public healthcare expenditure rose by 2.5% over the same period.
Current expenditure on healthcare accounted for 96.4% of total healthcare expenditure in 2012. The remaining 3.6% of total healthcare expenditure was capital expenditure.
Capital expenditure on healthcare in 2012 fell by -1.7% as compared to 2011, changing from £5.2bn to £5.1bn.
Volume of consumption of healthcare by UK households has fallen by -2.4% between 2007 and 2012.
Total healthcare expenditure per capita in 2012 rose by 1.2% as compared to 2011.
Total healthcare expenditure as a share of GDP was measured amongst the lowest of the G7 countries (Canada, France, Germany, Italy, Japan, UK, USA) with only Italy spending less as a share of their GDP across the series.
Figure 1 presents total healthcare expenditure in the United Kingdom, representing expenditure from both the UK public and private sector combined.
Total healthcare expenditure grew by an average annual increase of 8.0% for the period 1997 to 2009, but has slowed since. Total healthcare expenditure grew by an average annual increase of 1.6% between 2009 and 2012, bringing the overall average annual increase for the period 1997 to 2012 to 6.7%. Total expenditure on healthcare in the UK has risen from £54.6 billion in 1997 to £144.5 billion in 2012.
This reflects an international trend in the slowing of expenditure on healthcare from 2009 to 2012 (OECD, 2013).
Figure 2 shows the growth rates of total healthcare expenditure over the period 1998 to 2012.
The strongest growth in expenditure on healthcare in the UK was seen between 1999 and 2003 where growth rates were nearly all consistently over 9.0% apart from in 2001 where growth was still 7.0%.
After 2003, expenditure on healthcare annual growth rates were still high relative to the latter years of the series. Growth rates ranged from 6.9% to 8.1% from 2004 to 2009.
The final years of the series from 2010 to 2012 have seen expenditure on healthcare growth decline to far lower levels, although expenditure on healthcare in the UK has retained positive growth throughout the entire series. Growth rates in 2010, 2011 and 2012 were 1.0%, 1.9% and 1.9% respectively.
Figure 3 shows Total Healthcare expenditure per capita between 1997 and 2012.
Total expenditure on healthcare in the UK per capita has increased every year since 1997 however rates of growth have slowed since 2009. Average annual growth rates for total expenditure on healthcare per capita in the UK stood at 7.4% between 1997 and 2009. From 2009 to 2012 average annual growth has shrunk to 0.8%.
In 2012, total healthcare expenditure per capita rose by 1.2%. In 2008, total healthcare expenditure per capita rose by 6.5%.
Figure 4 shows total healthcare expenditure in the UK as a share of GDP, GDP annual growth rates, and Total Health Expenditure (HE) annual growth rates from 1998 to 2012.
Healthcare expenditure as a share of GDP in the UK rose steadily from 6.5% of GDP in 1997 to 9.7% in 2009, and then fell to 9.2% in 2011, where it remained in 2012. Years 2008 and 2009 saw the largest increases of 0.4 percentage points and 0.9 percentage points respectively. This is due to the slow down in GDP growth between 2007 and 2008 and fall in GDP in 2008 and 2009 while healthcare expenditure continued to rise.
Figure 4 shows the change in total expenditure on healthcare in the UK as a share of GDP over the period 1997 to 2012, and figure 5 then compares this internationally against the other G7 countries (Canada, France, Germany, Italy, Japan, UK, USA).
The Organisation for Economic Co-operation and Development (OECD, 2011b) suggests that over the past 50 years healthcare expenditure as a share of GDP has increased for most countries internationally. Total expenditure on healthcare in the UK as a share of GDP followed this trend until 2009.
Figure 5 shows Total healthcare expenditure in the UK as a share of GDP compared with other G7 Countries, between 1997 and 2012.
The main driver for the global increase in healthcare expenditure as a proportion of GDP in 2009 was that, following the global financial crisis, GDP in each of the G7 countries fell significantly. This was at a time when levels of healthcare expenditure were still rising, which accounts for the increasing levels of healthcare expenditure as a proportion of GDP.
There is a long term trend for healthcare expenditure as a proportion of GDP to increase, with movements between all G7 countries following the same patterns. 2012 data is only currently available for the United Kingdom, Canada and Italy and the latest data for Japan is 2010.
The higher than average rates of expenditure in the U.S. can be partially attributed to higher costs. This is in particular with regard to the price of pharmaceuticals, hospital services and the cost of physicians (OECD, 2009).
However price may not explain all of the difference in healthcare expenditure between US and the OECD average. For example, high volumes of elective day surgery and outpatient care have been suggested to be a factor where the rate of elective day surgery was approximately 4 times the OECD average in 2006 (OECD, 2009).
Figure 6 presents estimates of current and capital healthcare expenditure in the UK, between 1997 and 2012.
Capital expenditure increased from £3.0 billion in 1997 to its peak of £8.0 billion in 2008. It then fell by 35.4% to £5.1 billion between 2008 and 2012. The strongest capital expenditure growth was seen between 2004 and 2008, where expenditure rose from £4.0 billion to £8.0 billion respectively, representing a 100% increase. Over the entire series, capital expenditure has increased at an average annual growth rate of 3.8% between 1997 and 2012.
Current expenditure increased at an average annual rate of 6.8% between 1997 and 2012. An average annual growth rate of 8.0% was seen between 1997 and 2009 but expenditure slowed to an average annual growth rate of 2.3% between 2009 and 2012.
Current expenditure accounted for £51.7 billion in 1997 rising to £139.3 billion in 2012, representing 94.6% and 96.4% of total healthcare expenditure respectively.
Current expenditure experienced strongest growth in 2003 with an increase of 9.8%, and the weakest growth in 2012 at 2.0%. Capital expenditure saw its strongest growth in 2008 with a rise of 30.3%, and its weakest growth in 2010 with a fall of -19.0%.
Figure 7 shows Capital and Current expenditure shares in 1997 and 2012.
Comparing 1997 to 2012 there has been a small shift towards current expenditure as a share of total healthcare expenditure, increasing from 94.6% in 1997 to 96.4% in 2012. Capital expenditure as a share of total expenditure conversely fell from 5.4% to 3.6% over the same period. There have however been small fluctuations between these years. As a share of total healthcare expenditure, capital expenditure had increased relative to current expenditure from 5.4% in 1997 to 5.8% in 1999. It then fluctuated between 4.2% and 4.9% between 2000 and 2006, following which it increased to its peak of 6.2% in 2008. From 2009 to 2012 the share of total healthcare expenditure represented by capital fell from 5.7% to 3.6%.
Figure 8 presents estimates of public and private healthcare expenditure in the UK, between 1997 and 2012.
In 2009, public healthcare expenditure grew by 9.7%: the strongest annual growth rate since 2004 where growth reached 10.3%. Public expenditure on healthcare then slowed after 2009, with annual growth dropping to 1.9% for 2010 and 1.2% for 2011 and then rising to 2.5% in 2012.
Public expenditure on healthcare from 2009 to 2012 increased at an average annual growth rate of 1.9%. This is a lower figure than previous years where average annual growth between 1997 and 2009 was 8.3%. Average annual rate of increase during the period 1997 to 2012 was 7.0%.
The slow-down in growth in public expenditure on healthcare is a trend seen across Europe, and more widely, among OECD member states (OECD, 2013). The OECD report that the fall in average total healthcare expenditure across the OECD has been primarily driven by a collapse in the growth of public expenditure on healthcare since 2009, where average growth has been recorded as close to zero growth in both 2010 and 2011 for OECD member states.
Private healthcare expenditure is defined as private household spend on medical goods and services (in accordance with European System of Accounts 1995 (ESA 95) Classification of Individual Consumption by Purpose (COICOP) definition), private healthcare insurance, expenditure by Not for Profit Institutions Serving Households (NPISH) and private sector capital.
Private household spending on medical goods and services include goods such as over the counter pharmaceuticals and services such as dental services and private hospital services. NPISH includes charities and other non-profit organisations.
Household expenditure accounts for 68.3% of total private spending, with NPISH taking the next largest share at 23.5% in 2012. Private insurance and capital are estimated to account for the remaining 8.2% of total private expenditure.
Including all these elements, estimates of private expenditure on healthcare more than doubled between 1997 and 2008, rising from £10.7 billion in 1997 to reach £23.8 billion in 2008. However, private expenditure fell by -2.8% in the period 2008 to 2012 to £23.2 billion.
However, although private expenditure on healthcare increased at an average annual growth rate of 5.3% over the entire series between 1997 and 2012, average annual growth from 2009 to 2012 was flat at -0.1%. This is slower growth since the recession than has been apparent for public expenditure.
Slow growth in private expenditure on healthcare was driven by private household spending on medical goods and services on healthcare and is not unique to the UK. The OECD (2013) recently reported that private household “out of pocket” expenditure by OECD definition (which forms the majority share of household expenditure under COICOP definition – see methodology section for more information) also slowed down in many OECD countries in 2010 and 2011, as household incomes remained flat or decreased. For the UK overall private healthcare expenditure is estimated to have continued that trend of flat or decreasing growth in 2012. Data across the OECD for 2012 has not been released yet but will be available later in 2014 to make the comparison.
Figure 9 shows the public and private healthcare expenditure shares for the first and last years of the series, 1997 and 2012.
Public expenditure on healthcare accounted for the largest proportion of total UK expenditure on healthcare, representing £43.9 billion (80.4%) of healthcare expenditure in 1997 rising to £121.3 billion (84.0%) in 2012.
Figure 10 shows the private healthcare expenditure composition for the years 2000 and 2012.
Throughout the period from 2000 to 2012 the composition of private expenditure has remained roughly the same. Private household spending on medical goods and services formed the majority of private healthcare expenditure throughout the period 2000 to 2012.
There has been a slight increase in expenditure share for both private household spending on medical goods and services and healthcare insurance spending on medical goods and services, accounting for 1.4 percentage points and 1.8 percentage points respectively. The shares for NPISH and private capital expenditure have fallen slightly from 26.5% and 3.3% in 2000 to 23.5% and 3.1% by 2012.
Figure 11 shows the volume of private household healthcare consumption compared to other household consumption trends, between 1997 and 2012. This corresponds to the 68.3% of private expenditure on healthcare identified in Figure 10 in 2012 that is accounted for by households.
To place UK private household expenditure on medical goods and services in context, data taken from the ONS consumer trends report (ONS, 2013a) is presented in figure 11. This data shows the relatively rapid growth in consumption of healthcare related goods and services over the period from 1997 to 2007 when volume growth increases of nearly 50% were recorded. Since 2007 the volume of consumption of healthcare by UK households has fallen by -2.4%.
Items such as clothing and footwear, recreation and culture, and communication have all seen greater growth in consumption between 1997 and 2012 but consumption of communication and recreation and culture has levelled since the 2008 recession. Growth in consumption of healthcare related goods and services has remained low in comparison to these faster growing goods and services consumption trends. When considered over the entire series from 1997 to 2012 healthcare consumption index levels reached approximately 150 index points in 2012 when other goods and services have reached in excess of 200 index points at the same period.
The Organisation for Economic Co-operation and Development (OECD, 2011a and 2000) provide international guidelines on which this article’s expenditure figures are calculated. These expenditure figures are provided to OECD annually to enable international comparisons to be made regarding healthcare expenditure, such as Health Data 2012 (OECD, 2012). This is important as it allows the UK healthcare expenditure statistics to be more comparable, more policy relevant and recognised on an international platform.
The System of Health Accounts (SHA) definitions (OECD, 2000) do not include education and training or research and development but they can be classified as ‘related expenditure’.
It should also be noted that the new SHA guidance (OECD, 2011a) changes the focus of the main aggregate of healthcare expenditure to current expenditure only. Capital expenditure may be reported independently. UK Health accounts data is likely to have to comply with this standard by April 2016 under a forthcoming EU regulation.
The estimates of healthcare expenditure in the UK in this article are based on OECD guidance from SHA 2000 and are comprised of estimates from the Department of Health and the UK National Accounts produced by ONS. The National Accounts estimates are also sent to the European Statistical Office, Eurostat, to meet the requirements of the Maastrict Treaty (EU, 1993).
Table 1 outlines the adjustments to the base series of Government current and capital expenditure on healthcare.
|Government current and capital expenditure on healthcare||Base series||Consistent with data submitted to Eurostat in order to meet requirements defined in the Maastricht Treaty (EU 1993) and published in Blue Book 2013 (ONS, 2013b)|
|Household expenditure on private healthcare||Added||Published in Blue Book 2013 (ONS, 2013b)|
|Expenditure on private healthcare by NPISH (mainly charities)||Added||UK estimate provided by the Department of Health|
|Expenditure on healthcare in prisons||Added||UK estimate provided by the Department of Health|
|Expenditure on healthcare in the armed forces||Added||UK estimate provided by the Department of Health|
|Capital expenditure by private sector healthcare providers||Added||Estimated using data consistent with Blue Book 2013 (ONS, 2013b), and data submitted to Eurostat and published on the ONS website|
|Expenditure on healthcare and training of healthcare personnel by the National Health Service (NHS)||Deducted||UK estimate provided by the Department of Health|
|Expenditure on research and development in healthcare by the NHS||Deducted||UK estimate provided by the Department of Health|
|Government benefits paid to those providing home healthcare for their relatives||Added (no estimate available)||No source|
|Occupational healthcare||Added (no estimate available)||No source|
|Non-NHS expenditure on nursing care in nursing homes||Added (no estimate available)||No source|
Overall revisions to total healthcare expenditure have all been negligible with the greatest change being a -0.7% downward revision to total expenditure on healthcare in the UK in 2009. The main revisions in the report are seen in the private healthcare expenditure series and have happened as a result of supply - use balancing in the national accounts in 2013.
Although revisions are evident throughout the private expenditure series, these revisions are below 0.8% of total healthcare expenditure in the UK for any given year. The revisions are mainly downward in direction and relate specifically to both private insurance expenditure on healthcare and private household expenditure on healthcare in the UK. The largest revision to the private healthcare expenditure estimates is a change of -0.7% to the 2011 estimate.
See Reference Tables 3 and 4 for more information on revisions compared to previously published estimates (ONS 2013c).
European Union (1993). Maastricht Treaty. Luxembourg: Publications Office of the European Union.
OECD (2000). A System of Health Accounts, Organisation for Economic Cooperation and Development.
OECD (2009). Disparities in health expenditure across OECD countries: Why does the United States spend so much more than other countries? OECD Publishing.
Available at : http://www.oecd.org/unitedstates/43800977.pdf
OECD (2011a). A System of Health Accounts: 2011 Edition, OECD Publishing.
OECD (2011b). Health at a Glance 2011, OECD Publishing
OECD (2013). OECD Health Statistics 2013. OECD publishing.
ONS (2013a). Consumer Trends,2013 Q3.
ONS (2013b). United Kingdom National Accounts Blue Book 2013
ONS (2013c). Expenditure on Healthcare in the UK, 2011.
United Nations (2008), A System of National Accounts. United Nations, New York.
Current expenditure is recurrent expenditure on goods and services consumed within a year, necessary to sustain the production of healthcare services. Some small expenditure on items of equipment, below a threshold cost, is also included as current spending.
Capital expenditure is comprised of three components; Government healthcare capital transfers, government gross fixed capital formation and capital expenditure from private sector providers.
Capital transfers are classified by national accounts as ‘unrequited transfers where either the party making the transfer realises the funds involved by disposing of an asset (other than cash or inventories), relinquishing a financial claim (other than accounts receivable) or the party receiving the transfer is obliged to acquire an asset (other than cash) or both conditions are met’ (United Nations, 2008).
Gross fixed capital formation is measured by the total value of a producer’s acquisitions, less disposals of fixed assets during the accounting period, plus certain specified expenditure on services that add to the value of non-produced assets (United Nations, 2008).
Private sector capital expenditure is capital expenditure by private healthcare organisations.
For further definitions of national accounts see the System of National Accounts, 2008 (United Nations, 2008).
Public expenditure on healthcare is made up of all governmental expenditure on healthcare including expenditure in prisons and defence. Research and development and education and training in healthcare are not included (See table 1).
Private expenditure is made up of three main components; private households consumer spending on medical goods and services (as reported in Consumer Trends; ONS, 2013a), private healthcare insurance and private healthcare capital. In addition, private healthcare expenditure also includes non-profit institutions serving households (NPISH) which is largely made up of charities.
Private healthcare expenditure is based on final consumption expenditure on health by households and can be found in Blue Book 2013 (ONS, 2013b).
When OECD refer to private expenditure they typically refer to household expenditure only – or the System of Health Accounts definition of “out of pocket” expenditure. This differs from the private households consumer spending on medical goods and services (as reported in Consumer Trends; ONS, 2013a) which contains some insurance expenditure while the OECD ‘’out of pocket’’ expenditure does not. The difference should be taken note of when reading the article when OECD and ONS definitions are compared in the private expenditure on healthcare commentary in order to draw attention to similar post recession trends in private expenditure on healthcare in the UK and across the OECD.
Consumer trends private healthcare expenditure estimates:
The Consumer Trends publication (ONS, 2013a) presents comprehensive estimates of household final consumption expenditure (HHFCE), constructed to conform to the European System of Accounts 1995 (ESA 95) Classification Of Individual Consumption by Purpose (COICOP).
The following table breaks down private health expenditure by COICOP definitions. Category 6 Health represents the household final consumption expenditure on health whereas definitions 6.1-6.3 represent sub-catagories within category 6 health. See table 2 for full breakdown:
|6 Health||This division also includes health services purchased from school and university health centres|
|6.1 Medical products||This group covers medicaments, prostheses, medical appliances and equipment and other health-related products purchased by individuals or households, either with or without a prescription, usually from dispensing chemists, pharmacists or medical equipment suppliers. They are intended for consumption or use outside a health facility or institution. Such products supplied directly to outpatients by medical, dental and paramedical practitioners or to in-patients by hospitals and the like are included in outpatient services (06.2) or hospital services (06.3).|
|6.1.1 Pharmaceutical products||Medicinal preparations, medicinal drugs, patent medicines, serums and vaccines, vitamins and minerals, cod liver oil and halibut liver oil, oral contraceptives. Excludes: veterinary products (09.3.4); articles for personal hygiene such as medicinal soaps (12.1.3).|
|6.1.2 Other medical products||Clinical thermometers, adhesive and non-adhesive bandages, hypodermic syringes, first-aid kits, hot-water bottles and ice bags, medical hosiery items such as elasticated stockings and knee supports, pregnancy tests, condoms and other mechanical contraceptive devices.|
|6.1.3 Therapeutic appliances and equipment||Corrective eyeglasses and contact lenses, hearing aids, glass eyes, artificial limbs and other prosthetic devices, orthopaedic braces and supports, orthopaedic footwear, surgical belts, trusses and supports, neck braces, medical massage equipment and health lamps, powered and unpowered wheelchairs and invalid carriages, "special" beds, crutches, electronic and other devices for monitoring blood pressure, etc.; - repair of such articles. Includes: dentures but not fitting costs. Excludes: hire of therapeutic equipment (06.2.3); protective goggles, belts and supports for sport (09.3.2); sunglasses not fitted with corrective lenses (12.3.2).|
|6.2 Outpatient services||This group covers medical, dental and paramedical services delivered to outpatients by medical, dental and paramedical practitioners and auxiliaries. The services may be delivered at home, in individual or group consulting facilities, dispensaries or the outpatient clinics of hospitals and the like. Outpatient services include the medicaments, prostheses, medical appliances and equipment and other health-related products supplied directly to outpatients by medical, dental and paramedical practitioners and auxiliaries. Medical, dental and paramedical services provided to in-patients by hospitals and the like are included in hospital services (06.3).|
|6.2.1 Medical services||Consultations of physicians in general or specialist practice. Includes: services of orthodontic specialists. Excludes: services of medical analysis laboratories and x-ray centres (06.2.3); services of practitioners of traditional medicine (06.2.3)|
|6.2.2 Dental services||Services of dentists, oral hygienists and other dental auxiliaries. Includes: fitting costs of dentures. Excludes: dentures (06.1.3); services of orthodontic specialists (06.2.1); services of medical analysis laboratories and x-ray centres (06.2.3)|
|6.2.3 Paramedical services||Services of: medical analysis laboratories and x-ray centres; Freelance nurses and midwives; Freelance acupuncturists, chiropractors, optometrists, physiotherapists, speech therapists, etc.; Medically prescribed corrective-gymnastic therapy; Outpatient thermal bath or sea-water treatments; Ambulance services; Hire of therapeutic equipment. Includes: services of practitioners of traditional medicine.|
|6.3 Hospital services||Hospitalization is defined as occurring when a patient is accommodated in a hospital for the duration of the treatment. Hospital day-care and home-based hospital treatment are included as are hospices for terminally ill persons.|
|This group covers the services of general and specialist hospitals, the services of medical centres, maternity centres, nursing homes and convalescent homes which chiefly provide in-patient health care, the services of institutions serving old people in which medical monitoring is an essential component and the services of rehabilitation centres providing in-patient health care and rehabilitative therapy where the objective is to treat the patient rather than to provide long-term support.|
|Hospitals are defined as institutions which offer in-patient care under direct supervision of qualified medical doctors. Medical centres, maternity centres, nursing homes and convalescent homes also provide in-patient care but their services are supervised and frequently delivered by staff of lower qualification than medical doctors.|
|This group does not cover the services of facilities, such as surgeries, clinics and dispensaries, devoted exclusively to outpatient care (06.2). Nor does it include the services of retirement homes for elderly persons, institutions for disabled persons and rehabilitation centres providing primarily long-term support (12.4).|
The estimates that ONS use for NPISH are provided by the Department of Health. The current method used is to forecast data taken from survey results.
Move to SHA 2011:
Following the European Framework regulation (EC) no. 1338/2008, ONS is required to report health expenditure aggregates in accordance with the System of Health Accounts 2011 (OECD 2011a).ONS has initiated a development project to bring the health expenditure estimates in line with SHA 2011 definitions and to provide a full set of Health Accounts.
The UK health accounts development project is due to deliver its first estimates under SHA 2011 guidance in March 2016. There will be clear changes to be incorporated into the new presentation of healthcare expenditure estimates For example, it will no longer necessary to report capital expenditure under the SHA 2011 guidance and a proportion of what was previously regarded as social care may fall into expenditure on long-term healthcare, increasing estimates of expenditure on healthcare in the UK.
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