LAURA R. AZIZ MICHAEL S. CULLEN
The United Kingdom, which comprises Great Britain ( England, Scotland, and Wales) and Northern Ireland, was once the center of a worldwide empire, on whose colonies "the sun never set." This island nation has had a global impact on medical education far greater than its size or numbers alone would predict. The United Kingdom also has been a pioneer in instituting a comprehensive health care delivery system and supporting the primary care general practitioner.
In 1990, the United Kingdom had a population of 57.4 million ( England, Wales, Scotland and Northern Ireland), with 91 percent in urban areas and 9 percent in rural districts. There was approximately one physician for every seven hundred persons, relatively equally distributed throughout the country; this included one general practitioner (ambulatory care) per 1,900 persons. Birthrate per 1000 population was 13.9, and death rate was 11.2 per 1,000; the infant mortality rate was 7.9 per 1000 live births ( 1990). In 1988, life expectancy at birth was 72.4 years for males and 78 years for females. The per capita GNP was $8,570 US ( 1988). Virtually 100 percent of the population is literate.
The British National Health Services (NHS) is both comprehensive and highly centralized. This comprehensiveness is dual: it provides universal coverage to the whole population and coverage includes the whole range of health services. The British NHS differs from other national systems in organizational structure and in financial mechanisms that avoid the complexity of multiple independent financial sources ( Roemer 1991).