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The Cost Incidence of the U.K.'s NHS System

Author

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  • Paul J M Klumpes

    (Tanaka Business School, Imperial College London)

  • Liyan Tang

    (Tanaka Business School, Imperial College London)

Abstract

We examine the cost incidence of the United Kingdom's National Health Service (NHS) through application of the concepts of fiscal imbalance (FI) and generational imbalance (GI). We find significant disparities of costs by gender, region and type of NHS expenditure. The financial sustainability of publicly funded health care systems is sensitive to the demographics of ageing population. Historical and current trends in the demographic structure of U.K.'s population also impact these structural imbalances underlying the system. The pay-as-you-go (PAYG) financed funding status of NHS based on both currently required cash-based accounting principles and proposed accrual-based accounting principles is criticised for not recognising the continuing service obligations of the U.K. Government under the NHS. A combination of FI and GI largely explains the under-funding of the NHS. Data are taken from both historical trends in expenditure and ageing as well as projected demographics. The analysis implies that there is a significant inter-generational inequity in the funding of the NHS.

Suggested Citation

  • Paul J M Klumpes & Liyan Tang, 2008. "The Cost Incidence of the U.K.'s NHS System," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 33(4), pages 744-767, October.
    • Handle: RePEc:pal:gpprii:v:33:y:2008:i:4:d:10.1057_gpp.2008.29
    DOI: 10.1057/gpp.2008.29
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    1. Stewart Lawrence & Manzurul Alam & Tony Lowe, 1994. "The Great Experiment: Financial Management Reform in the NZ Health Sector," Accounting, Auditing & Accountability Journal, Emerald Group Publishing Limited, vol. 7(3), pages 68-95, September.
    2. repec:eme:aaaj00:09513579410064123 is not listed on IDEAS
    3. Wai Fong Chua & Alistair Preston, 1994. "Worrying about Accounting in Health Care," Accounting, Auditing & Accountability Journal, Emerald Group Publishing Limited, vol. 7(3), pages 4-17, September.
    4. Christian Hagist & Laurence Kotlikoff, 2005. "Who's Going Broke? Comparing Growth in Healthcare Costs in Ten OECD Countries," NBER Working Papers 11833, National Bureau of Economic Research, Inc.
    5. Loeb, Stephen E., 1987. "Population aging: Some accounting considerations," Journal of Accounting and Public Policy, Elsevier, vol. 6(3), pages 157-167.
    6. Jagadeesh Gokhale & Kent Smetters, 2003. "Fiscal and generational imbalances: new budget measures for new budget priorities," Policy Discussion Papers, Federal Reserve Bank of Cleveland, issue Dec.
    7. repec:eme:aaaj00:09513579410064097 is not listed on IDEAS
    8. Kent Smetters & Jagadeesh Gokhale, 2003. "Fiscal and Generational Imbalances: New Budget Measures for New Budget Priorities," Books, American Enterprise Institute, number 52628, September.
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