Bismarck versus Beveridge revisited: Does the model shape the outcome?

In this context, old questions have re-emerged with renewed force: are the NHS’s core principles – free-at-the-point-of-use and funded through general taxation – still fit for purpose?

In this report, we analyse data from 22 OECD countries to examine evidence on alternative funding approaches – principally social health insurance systems, as used in France, Germany and the Netherlands – and their relationship to performance indicators across five domains: capacity, access, equity, quality, and efficiency. 

We find that the causes of poor NHS performance are not structural but practical, and set out four areas in which targeted investment would make the most difference for the NHS.