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The NHS 75 years on: What was the long-term impact of making health care free at the point of access?

By Chris A Garrington, on 8 November 2023

The fact that the NHS has reached the age of 75 years has been widely celebrated – but key questions remain about its influence over health, education and economic outcomes. In this post, Genevieve Jeffrey describes research which uses census data  to uncover the far-reaching consequences of the introduction of free health care over the course of 40, 50, and 60 years. It reveals this monumental event impacted not just on individuals’ health and well-being but also on their educational outcomes.

One of the most significant changes brought about by the introduction of the NHS was the elimination of financial barriers. Before its introduction, the cost of medical care during pregnancy and childbirth posed a burden on women and their families. The NHS introduction changed this by providing free access to essential healthcare services during gestation and at birth. The introduction of the NHS negated worries about saving for health costs and navigating the availability of doctors and midwives. This enabled expectant mothers to access healthcare without delay.

This change was important, particularly in preventing complications through timely access to antenatal care. But were there wider longer-term effects?  To delve into this, we harnessed the power of the Office for National Statistics Longitudinal Study (ONS LS). Because this enabled us to break down our sample by exact dates of birth, we could compare the outcomes of those born in the 18 months before July 5th, 1948 – the date of introduction of the NHS – with those born in the 18 months after. The two groups had very similar access to healthcare and to other social services such as education, with one major difference: the mothers of those born in 1946 and in early 1947 did not have free healthcare while pregnant and while giving birth.

Health outcomes

We were able to look at how those in our sample reported their own health later in life, using questions in the census from 1991 onwards about whether they had a long term life-limiting illness and from 2001 on how they saw their own health, from ‘very good’ to ‘very bad.’  We found individuals born after the NHS introduction were more likely to report having no long-term limiting illnesses in their 40s. And we uncovered a noteworthy improvement in self-reported health among those born after the NHS introduction when they were in their 50s and 60s, with respondents more likely to rate their health as ‘good’ compared to those born before.

When assessing objective measures related to cancer, such as cancer incidence, age of first cancer diagnosis, and the sum of cancer events per diagnosis, no significant effects were found. While self-reported health improved, there was no discernible change in cancer-related outcomes.

The impact on economic outcomes

The study also investigated the impact of the NHS on education outcomes. While we found no difference between those born under the NHS and just before it in terms of obtaining no educational qualifications, there was an increase in the likelihood of obtaining a university degree or higher qualification among those born just after the NHS introduction.

Prior research could provide a clue as to the mechanisms that drive these effects. Greater access to healthcare during gestation and at birth can improve the health stock of individuals at birth, and these impacts compound throughout the life course, also impacting educational outcomes. Of course, all of this generation – whether born just before the NHS or just after – benefited from the free secondary education introduced under the 1944 Education Act, and they also benefited from the expansion of the universities which followed the Robbins Report of 1963. The effect on educational outcomes found in our research is separate to the effects of these policies and represents the effect of access to the NHS during gestation and at birth.

Besides education we also looked at the number of hours our sample worked in their 50s and found no significant impact associated with the NHS introduction. Similarly, outcomes for home ownership in the 50s and 60s , serving as a proxy for economic status, displayed no significant effects.

The lasting legacy of the NHS

Our findings underscore the enduring impact of the NHS on the health and education of individuals. Access to healthcare during critical life stages, such as pregnancy and childbirth, carries long-term ramifications for both individuals and society. It not only enhances individual health but also contributes to a more educated population.

While this research provides valuable insights, it also poses vital questions for future exploration. How can healthcare systems be further refined to impact on long-term health outcomes? What are the key pathways through which health at birth impacts on educational attainment in the UK?

These questions are pivotal for policymakers and researchers as they shape the future of healthcare and education policies. The focus of the study was on those born in the months around the NHS introduction. It would be important to also investigate the impact on other segments of society to gauge the true extent of the impact of the NHS introduction.

The introduction of the NHS in 1948 triggered profound and enduring effects on the health, education, and opportunities of individuals in the UK. Our findings underscore the long-term benefits of offering accessible healthcare services, particularly during critical life stages like pregnancy and birth. This study reinforces the significance of upholding and fortifying such healthcare systems, especially during global debates about healthcare access.

As we reflect on the legacy of the NHS 75 years on, this research serves as a potent reminder of the positive societal outcomes achievable when healthcare is a universal right. It encourages us to envision ways to enhance healthcare and education systems for the betterment of individuals and society at large. The NHS remains a shining example of what can be achieved when healthcare is made universally accessible.

Genevieve Jeffrey is a fellow in the LSE Department of Health Policy, and this research formed her PhD thesis.

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