NHS vs Private Healthcare - An American Perspective

Curious about NHS vs private healthcare once you move to the UK from the USA? The NHS vs private health insurance debate may not be top of mind for your move to Great Britain, but is one of the most frequently asked questions I receive from new American expats:

What’s NHS vs private healthcare like? And what do you do when you visit America?

In this post, I share my own experiences receiving treatments from medical professionals at private UK hospitals and NHS ones. While I can’t advise if private treatment is better than the NHS and vice versa, what I can offer is an American perspective.

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Table of Contents

The Disclaimer Stuff

I’m not a healthcare professional and have no ties to either the NHS or any medical institution in the UK. This post is simply a summary of personal experiences to give examples of what my healthcare visits were like at both private and NHS hospitals. There is no right or wrong, but simply what I chose for medical services to handle the different scenarios that warranted medical care while living in England.

Your healthcare decision is a private one based upon your own conditional needs and means. This post is not meant to decide which route is best suited for you, but to offer visibility into what receiving medical services can be like in Great Britain. I’ve included insurance links to help with your healthcare research. Some of these are affiliate links which means I make a small commission if you make a purchase. The links included in the post are intended to be helpful to make your own research a little bit easier. I would never recommend a product or service that I wouldn’t consider for myself or my family. Read here for the full disclosure policy.

Lastly, my family is a healthy family of four consisting of 2 adults and 2 kids. There are no medical conditions that warrant regular medical care or healthcare services beyond the occasional emergency and annual preventative check-ups.

NHS vs Private Healthcare Costs

Before getting into what the NHS is like vs what private healthcare is like, let’s review costs for both.

NHS Healthcare Costs

The NHS is free for UK residents and some visitors not ordinarily in the UK (mostly EU). And coronavirus related issues are covered 100% for even non-EU visitors. This is a huge benefit compared to living in America.

The only NHS expenses I incurred while living in England were pharmacy related. The amount spent on pharmacy expenses in the UK was minimal compared to the US. You can find a summary about the NHS and other essential need-to-know things in this broader moving to the UK post.

For an estimate on prescriptions, you can forecast using this NHS reference (and add to your expat negotiation kit here).

Beware that not all prescriptions available in the US are available overseas. There are different government restrictions between the US and the UK so do not assume like-for-like. You can find some drugs not available in the UK in this what to bring from USA post.

If you require a certain medication, check in advance if the drug is available. Consult with your doctor about your medical and pharmacy related needs before moving abroad.

Private Healthcare Costs In England

Private healthcare was negotiated as part of our terms in our expat assignment. If global healthcare coverage is a must for you, be sure to request inclusion in the terms of your deal. If your expat offer does not include private insurance but is a requirement you have for moving abroad, you can purchase directly out-of-pocket. Companies like Expat Financial offer global insurance options catered towards expats and global nomads alike.

My family used Cigna International for global medical insurance. The process of making a doctor appointment, which you can catch a glimpse of here, is a bit different than making one in America but is streamlined from a cost and payment perspective compared to America.

We were covered at 100% through Cigna which was an amazing benefit (and one I truly miss after repatriating to Texas).

Global private insurance not only allowed us to see private doctors in the UK but also allowed us to maintain routine doctor visits for annual check-ups or prescription refills during return trips to the USA. Global healthcare insurance offered peace of mind during extended trips between the UK and the USA.

Cigna International aside, there are many global healthcare options available. Cigna was chosen for us through our employer and having global coverage turned out to be an amazing expat benefit.

Healthcare expenses even with private insurance and NHS

Although our family was covered from a medical perspective with the NHS, and also Cigna International, we still incurred some medical-related expenses while living in the UK. Some of this was self-inflicted but nevertheless sharing for awareness in the event you find yourself in a similar situation:

1 – Pharmacy prescriptions for my husband and myself. Kids’ prescriptions are free.

2 – Eye contacts – I ordered and paid for eye lenses directly. In the UK you don’t need an annual prescription in order to buy contacts in the event you run out. So, admittedly I was lazy on ensuring annual eye exams and took the easiest path of simply reordering whenever I ran out. While I’m not suggesting delaying an annual eye exam, it is nice having the convenience of ordering eye contacts directly without your doctor’s approval. A box of my 90-day lenses costs approximately £30 on Alensa but will vary by brand and type.

3 – Dental – We continued our dental cleaning visits on return trips to the USA and paid for this through a monthly insurance premium (our choice). A number of occasional filling emergencies surfaced for my son in the UK. We used a lovely private dental office in Berkhamsted and no visit ever exceeded £100 out-of-pocket.

Coincidentally, I did get a quote for Invisalign while living in the UK and it’s not entirely different cost-wise compared to the USA when you factor in dental insurance.

There could be other healthcare expenses but this is all that we personally dealt with as a result of our own medical, eye, and dental issues while in England. Again, offering transparency for Americans so that it is not assumed that all healthcare-related needs are free in the UK. Be sure to add your anticipated healthcare expenses to the list of 19 expenses for living in England.

St Albans Storefront with NHS rainbow art

NHS childrens art covers storefronts like at this St Albans pub

NHS & Private Insurance – can you use both?

Yes! It should be clear by now, but yes. You can use the NHS and you can see a private doctor.

When you go private, you don’t need to provide NHS information although they may ask for your GP for transfer of documentation.

And when you see the NHS, you don’t need to provide insurance information. Once you find and register with a GP surgery after you’ve moved to the UK (top 10 things to do immediately after you’ve relocated from the US), you can start booking appointments.

Also, the reference to surgery when registering with a GP is synonymous with becoming a new patient at a doctor’s office or clinic in the USA. The word “surgery” threw me off when I was first sorting this out as a new British resident.

NHS vs Private Healthcare – how I chose to use each

If you have private health insurance you may opt to use private hospitals right out of the gate. In our case, we had no reason to not try the NHS. After all, the NHS is world-renowned and part of the entire British experience.

For that reason, we used the NHS for everything we could, and private healthcare for advanced issues that required a specialist. In our family case, we used private insurance for dermatology issues.

What the NHS is like

Our family experience with the NHS ranged from subtle flu-like visits to downright bloody emergencies. Here are the NHS highlights:

Getting a same-day appointment for a well visit is similar to the USA. You have to call the GP between 8 and 8:15 am to try to secure an appointment. During occasions where I was not able to secure an appointment, a GP was able to call and talk through symptoms over the phone.
Rarely did we ever see the same GP. This made it difficult to secure any sort of relationship.
Prescriptions are not easily given out and over-the-counter medications to self-serve an illness are limited compared to America. Multiple NHS visits for the same visit were required to finally secure a prescription for an illness.
No bill statements or invoices for services rendered EVER! (So nice.)
When my husband was super sick for a period of time, a GP called regularly to check on his status. So despite not maintaining a consistent relationship with a GP, we did experience a situation(s) where a deeper care of service manifested itself.
NHS A&E is similar to urgent care in the US. It’s not quite the emergency room but it’s also not the same as seeing your GP at a surgery hospital. NHS A&E is sort of in that middle/gray area.
An NHS A&E visit is truthfully not that entirely different than what you might expect at an American urgent care clinic: long waits, minimal sympathy, and sometimes no answers. To be fair, I only used an NHS A&E once. I waited for 3 hours only to be told there was absolutely nothing wrong with me, and to go home. I was prescribed nothing and at the time needed to at least feel heard. My mother had recently died from cancer and I had already been seen and been prescribed an antibiotic from an urgent care facility in the US that did not work. I went for at least 3 months with severe pain in my thumb (a very weird area for stress to manifest itself but oddly it did). Understanding that rarely an urgent care visit is ever pleasant, the minimum expectation was at least some form of recommendation or next step as to what to do. Needless to say, my private health insurance kicked in. More about that story below.
NHS Hospital is not that different from what you might expect at an American hospital emergency room but without the expense: long waits but results. Our experience with the NHS Hospital in Watford was nothing short of great. There was an exceptionally long wait but the doctor treated my husband’s head wound immediately upon being seen. He jumped too high and smacked into the door molding (2nd floors and up in old British houses are shorter than 1st floors; ceiling height was a sign of wealth) while playing Nerf guns with the kids and severely cut his head open. He actually knocked himself out. Not kidding. Really. This happened around 9pm on a Friday night, about 6 hours before we had to leave to catch a flight to Zurich. Although the wait was long, the NHS doctor was amazing according to my husband. She glued his forehead in a jiff (simplifying the series of events here) and told him to keep his travel plans to Zurich. Today, you’d never know he had a 4” bloody gash on his forehead that was glued back together by a lovely NHS doctor as a result of miscalculating the door height while playing a silly game of Nerf. Our only regret that night (apart from miscalculating the door height) was that my husband didn’t take an Uber or cab to the NHS hospital. It was a long wait overnight, and after that sort of trauma, a taxi is always best. Gas expenses aside, the NHS hospital visit cost us nothing.

Rainbow flower garden at Cardiff Castle, Wales

NHS maternity and what to expect

If you are planning to have a baby abroad while living in the UK, be sure to research what to expect for maternity services using the NHS.

Since I did not have a baby while living in England, it’s not fair for me to comment on what to expect or pros and cons. However, the most common theme I hear from American women having a baby with the NHS is to expect a minimalist approach (ie, shared room, minimal supplies, quick return to home, etc). The general sentiment I hear from Americans who have babies in Britain is that America does this better.

You can learn about what to expect for NHS maternity services here. For an idea of what having a baby costs using private healthcare vs NHS, Wise published these baby estimates in 2018.

Wise published some expenses to have a baby in the UK (2018)

What private healthcare is like in UK

Our family experience with UK private healthcare was entirely focused on dermatology visits. 3 out of 4 family members required special dermatology care while living in England. Here are the highlights:

Finding a private healthcare professional in the UK is similar to finding one in America. Ultimately word-of-mouth recommendations are how I found our private dermatologist, in conjunction with research on the Cigna International website.
With a private doctor in the UK, you are able to establish a relationship. My private doctor got to know nearly every member of my family which made repeat visits easy. It also eased my son’s mind when a procedure had to be performed; familiar face and not someone new. Since the doctor was familiar with the history of visits, it reduced time in the office. He was also incredibly sympathetic and supportive when my mother passed away. Some time in his office was literally spent just talking through how I was doing and managing the grief, coupled with distance and inability to seek support from family overseas. Very grateful for that.
Scheduling appointments using private insurance is a bit different than NHS or scheduling a doctor appointment in America. Consult with your private insurance company prior to scheduling a doctor appointment. The steps I followed to create an appointment at a private hospital using private insurance: 1- Contact insurance company to request a reference number to use for a new doctor visit, 2 – Provide patient details to the insurance company, 3 – Contact private healthcare office to book the appointment and provide the reference/authorization number. This reference number can be used for follow-up visits on the same issue. Otherwise, contact your insurance company for a new reference number for a new issue.
You can book the appointment first, which is useful information to provide the insurance company when requesting the reference number. However, provide the reference number back to the doctor’s office prior to the actual office visit. This helps streamline invoices so that payment is managed directly between the private hospital and the insurance company. I received a number of bills for visits where we did not provide the reference number in a timely manner which meant busy work for me to sort out the details for payment. In the end, all private healthcare visits in the UK were covered at 100%.
Holidays. Since we chose an individual doctor to handle all of our dermatology needs, there were several occasions where he was on holiday. While this isn’t entirely different from using a private healthcare office in the USA, the difference is the amount of holiday time Europe has versus America.
My private doctor was on holiday when I went to the NHS A&E. Since the NHS sent me home with nothing more than “nothing is wrong with you”, I did end up seeing one of my private doctor’s colleagues in England. The backup doctor tried to resolve my issue but ultimately made it worse. In the end, my primary doctor immediately diagnosed me upon return from holiday and resolved my issue over treatments and time.

A Notable Difference about US vs UK Healthcare

The most immediate difference observed between receiving care in the US vs care in the UK is the reactive vs preventative healthcare approach.

This doesn’t differentiate that much between NHS vs private healthcare, but an important distinction between the US and UK.

You need to take the lead in being proactive about your own health. That’s true no matter where you live, but we found it even more so living in the UK.

There are no annual reminders or requests to go back for a follow-up, or that 9-year-old well check. In fact, in the 3 years my kids were British residents, their NHS GP never requested to see them. The only time they saw their NHS GP was for a sick visit.

This can be a blessing when the number of follow-ups seem overkill (and expensive) in the US. My best advice is to take control of managing routine check-ups yourself in the UK. No one from the NHS will be calling to remind you over and over about that mammogram you forgot to schedule.

NHS is part of Britain’s core as seen here at Raindrops On Roses

NHS Rainbow & why it’s special

It’s impossible to write about the NHS without referencing its heroic role in the pandemic. While private hospitals certainly deserve the same credit, it’s the NHS that more visibly received nationwide support.

I will never ever forget summer nights of 2020 at 8pm in England. It was a time where everyone was allowed to open their front doors, see their neighbors from a distance, and clap for the NHS. The entire country came together for this unified moment every night. It is still a very emotional memory to even write about.

Rainbows were painted by children as art on windows for passersby to see and started to appear in storefront windows, flower beds, and more. Rainbows became the symbol that united everyone everywhere in the UK for a better tomorrow, and NHS workers were the heroes behind it. John Lewis even started making NHS rainbow products to raise money for NHS charities.

Regardless of whether you choose NHS vs private healthcare while living abroad, you’ll quickly build a sense of respect and gratitude towards the NHS after living in England. It’s another top reason to enjoy living in the UK. It’s part of the country’s core foundation that doesn’t exist in America, but you will immediately understand it once the British culture sets in.

Final Thoughts On NHS vs Private Healthcare

My personal healthcare journey while living in England is just an example of how my family chose to use the NHS and private healthcare combined. We had the privilege of global healthcare coverage at 100% which isn’t a guaranteed benefit for Americans negotiating an overseas assignment. Private healthcare offered us liberties to receive medical treatments regardless of where we were in the world.

Consult your physicians while living in America before you move abroad. Evaluate your own medical needs against what you require to live abroad comfortably and safely. The NHS might be all that you want and need, or perhaps you’re seeking a combo of both. If your employer won’t offer global insurance, research options available like Expat Financial that do.

Either way, USA or the UK, NHS or private, finding the right doctor and plan that’s right for you is always a journey in and of itself. But hopefully, this post has given you American insights into what the NHS is like, what UK private healthcare is like, and what questions you want to further research or negotiate as part of your overseas move.

If you’re still uncertain or confused about anything I mentioned in this post, feel free to ask me in the comments.

Looking for more expat guides to living in the UK? Try these.

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NHS vs Private Healthcare – An American Perspective