Despite public support for the NHS, satisfaction levels have fallen, raising thoughts of reform.
We love the NHS. We clapped for health workers and carers in the first wave of the pandemic. A large majority of us want to keep an NHS which is free at the point of use for all.
People can choose which fund they sign up to. These are paid for by deductions from wages with employee and employer contributions. Some small out-of-pocket payments are required for hospital visits and medicines. The German system is better staffed and stocked than the UK, relative to the population. Analysis by Nuffield Trust shows in 2019 the UK had around nine nurses per 1,000 people, while in Germany there were about 14. The disparity in bed numbers was wider - with Germany's eight beds per 1,000 patients more than three times higher than the UK figure.
There is no clear evidence that the system itself is the key factor in driving health outcomes. It could be that Germany, as a relatively rich country and with fewer inequalities, has a healthier population.For the UK to switch to a German model would require a major structural upheaval, with a large bill attached.
Another think tank, the King's Fund, has argued that properly designed social health insurance can provide comprehensive cover to all in a similar way to tax-funded systems, but it says administrative costs can be high.
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