National Health Service United

There is not a bottomless pit of resources, says Phil Wadeson, finance director for the National Health Service unit that oversees hospitals and doctors offices in Liverpool. We reached the point a while ago where there is far more medical intervention than any health-care system can afford. ... 

National Institutes of Health. The management of sickle cell disease. NIH Pub. No. 02-2117. Bethesda, MD, Division of Blood Diseases and Resources, Public Health Service, United States Department of Health and Human Services June 2002 1-88. 

In the United Kingdom, annual expenditure on the National Health Service (NHS) is... 

In the United Kingdom, prescriptions are required for all medicines supplied under the National Health Service (NHS) and for all prescription-only medicines. Prescriptions may only be written by a doctor or dentist registered in the United Kingdom. 

The National Health Service spends more than 8.6 billion a year on medicines, yet this represents less than 13 per cent of its total expenditure. Medicine exports are worth over 10 billion a year - the United Kingdom s third largest foreign exchange earner in manufactured goods. Nearly a quarter of the world s top 100 medicines were discovered in Britain. 

Third, economic data are more important when there is substantial budgetary impact. In some jurisdictions, technologies are selected for appraisal only if they have a substantial impact on the (national) health service (e.g., in the United Kingdom), or if the manufacturer wants a premium price over other drugs to treat the given health condition (e.g., in the Netherlands). In addition, in several countries the authorities require an estimation of overall budgetary impact as well as the incremental cost-effectiveness ratio. 

In the United Kingdom, the Department of Health asks NICE to evaluate health technologies that have a major impact on the National Health Service. Although not formally based on efficiency considerations, this approach is more consistent with obtaining the best value for money from the use of resources on economic evaluation. More recently, methods involving the estimation of the expected value of perfect information have been used in a pilot study to inform research priorities in the United Kingdom (Claxton et al. 2004). 

Public Health Service, United States National Inshtute for Occupational Safety and Health... 

In 1996, total health care expenditure in the United Kingdom was approximately 7.0% of the GDP. Public expenditure by the National Health Service (NHS) accounts for most of the health care costs. The NHS was set up after World War II, with the aim of unifying health care services by voluntary and local hospitals. The NHS offers free health services to all U.K. residents, funded through general taxation. 

Funded by the government, the National Institute for Clinical Excellence (NICE) was set up as a Special Health Authority in the United Kingdom in 1999 and, as such, it is a part of the National Health Service (NHS). It was set up to provide the NHS (patients, health professionals, and the public) with authoritative, robust and reliable guidance on current best practice. Its key functions are to appraise the clinical benefits and the costs of those (health care) interventions and to make recommendations. Guidance is issued from each appraisal based on the clinical benefits,... 

Generally, there is no contract between the pharmaceutical company and the patient who is prescribed the product by a doctor. In the United Kingdom, it has been held that where a product is prescribed under a National Health Service scheme, it is not prescribed as a result of a contract between the pharmaceutical company and the patient because legislation exists that requires a pharmacist to supply the product on the production of a valid prescription. For nonprescription, over-the-counter (OTC) products, there is a contract between the retailer and the consumer who purchases the pharmaceutical product, but there is still usually no direct link in contractual terms to the manufacturer of the product. It may be, however, that the contract between the manufacturer and the retailer contains an indemnity provision. Then, in the event of a successful claim for breach of contract made against the retailer by the customer, the manufacturer would effectively be required to reimburse the retailer for the amount ordered to be paid in compensation to the customer. 

National Health Service. The government does not have to adhere to the recommendations by the NICE in its guidance and financial payment to health care providers. However, many believe that a negative recommendation from the NICE will have a detrimental impact on the pricing, reimbursement, and sales of the appraised product not only in the United Kingdom but also throughout Europe, Australia, and Canada. 

Nowadays a drug company has not only to show its paymasters - governments, insurers and so on - that its new prodnct is safe and works, but also that it is cost-effective. In Anstralia, this has been spelled out in legislation. Since 1993, any drng submitted for approval must be accompanied not only by the resnlts of clinical trials bnt also by an economic impact analysis. In 1999, the United Kingdom set np a National Institnte for Clinical Excellence (NICE) to advise the National Health Service on the cost-effectiveness of health care technologies. Other countries ask formally or informally for pharmacoeconomic analysis. Economic impacts can be measured in a variety of ways, for example, cost-effectiveness, cost-utility or full cost-benefit stndies. 

In the United Kingdom, the government controls the cost of pharmaceuticals not by limiting individual product prices, but by setting a cap on the profit that individual pharmaceutical companies can enjoy from their business with the National Health Service. Each company negotiates with the Secretariat of Pharmaceutical Price Regulation Scheme (PPRS) a total rate of return on the capital employed in generating its sales to the British National Health Service (NHS). 

These finding s demonstrate the immense economic dependence of psychiatrists on institutional employment. In other Western countries, where economic opportunities and social demands for private psychiatric services are much less than in the United States, the proportion of psychiatrists working in mental and other institutions is even greater. In Britain, for example, only 4.5 percent of the psychiatrists spend more than half their working time in private practice 69 percent are employed on a full-time basis in the National Health Service and 77 percent spend at least part of their time engaged in the treatment of hospital inpatients (as against 51 percent of American psychiatrists). In communist countries, all psychiatry is, of course. Institutional Psychiatry. 

In the United Kingdom, for example, all residents are covered by the National Health Service (NHS) and access to drugs is subsidised directly, leaving only a minor role for private health insurance and a nominal charge to be borne by the patient. In the United States, at the other extreme, health insurance is voluntary and in the hands of proht-driven private insurance companies, leaving only a residual role... 

K. Payne, B.M. Ryan-WooUey and P.R. Noyce, Role of consumer attributes in predicting the impact of medicines deregulation on National Health Service prescribing in the United Kingdom, International Journal of Pharmacy Practice 6 (1998),... 

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