Patients drift towards paying for hospital care out of their own pocket across all four UK countries

Since the pandemic there has been a 30% increase in the number of people paying out of their own pocket for hospital care across the UK’s four countries, with the starkest rise being a tripling of self-payers (up 218% from 800 to 2,560 per quarter) in Northern Ireland. This may be being forced by a lack of timely access to NHS provision rather than a planned extension of the self-pay private sector, warns the Nuffield Trust in a new briefing published today.

Calculations by the Nuffield Trust based on PHIN (Private Healthcare Information Network) data for admissions and day cases paid for out-of-pocket show that, between September 2019 and 2023, the number of patients paying out of their own pocket more than doubled in Wales (up 124% from 1,865 to 4,100) and almost doubled in Scotland (up 80% from 2,835 to 5,165). In England, which continues to have the highest number of privately funded care relative to its population, there was a rise of 20% from 45,000 to 54,000.

Across the four countries, the number of admissions and day cases covered by private healthcare insurance has also grown since the pandemic (up 5%), although this growth is more recent towards the end of 2023. Proportionally, Northern Ireland again sees the biggest increase in hospital care covered by private healthcare plans (a rise of 250% during the same period).

Overall, the data illustrates a rapid trend within the smaller countries of the UK, with sharp increases in privately funded and insurance funded healthcare with Northern Ireland, Wales and Scotland getting closer to the levels of private healthcare more commonly seen in England.

Much of this increase is likely driven by record waiting lists, which deteriorated further during the pandemic. However, the authors warn that the rise in private sector provision risks entrenching health inequalities by determining the availability of care based on financial resource rather than need in a context of general scarcity.

The Nuffield Trust data briefing How has the role of the private sector changed in UK healthcare? also explores an increase in private care delivery funded by the NHS:

• Despite record levels of staffing and greater levels of funding within the NHS, trusts in England provided fewer hospital admissions in 2022/23 than before the pandemic, illustrating a productivity challenge within the health service.
• Since the pandemic there has been substantial growth in spending by NHS trusts in England on private care. Spending has nearly doubled (an 88% increase) between 2019/20 and 2022/23.
• The proportion of patients in private hospitals in England has risen from 5.6% before the pandemic to 7.5% in 2022/23.
• Data from PHIN suggests that, on average, 30,000 more patients a week are being treated privately within the NHS in England.

Mark Dayan, Nuffield Trust’s Policy Analyst and Head of Public Affairs, said:

“While the vast majority of care remains NHS funded and delivered, there has been a definitive shift in all four UK countries towards private healthcare either funded out of pocket or to a lesser extent through private healthcare plans.

“Scotland, Wales, and Northern Ireland have seen the starkest rises in those turning to private healthcare provision. In Northern Ireland this more than tripled and could reflect patients grappling with the longest waiting times in any UK countries. At the same time, the English health service is once again starting to make more use of private providers itself, insofar as its budget can stretch.

“The private sector offers people more treatment at a time when many are in need and the health service is struggling to respond. But this shift raises difficult questions. The NHS could come to be reliant on private capacity without increasing what it can deliver. That capacity won’t always be in the right places, and at times there will be bidding against the health service. As more people shuttle from private care to NHS care and back, there is a risk that they will jump the queue, or fall through the cracks of disjointed information systems.

“The fact that more people are paying out of pocket at a time when the economy is tight and difficult, not a time of plenty, suggests they are turning to the private sector out of desperation as NHS provision flatlines. That means that the balance of care is very slowly shifting from care based on need, to care based on willingness and ability to pay.”