Health Care Around the World

Healthcare Outsourcing in the UK

Many liberals laud Europe’s government-run health care sectors as a model to emulate.  In particular, Great Britain’s National Health Service (NHS) often is seen as the ideal single payer system.  In reality, however, the British government itself does not supply all services.

A study from the Public Services International Research Unit (PSIRU) describes the gradual trends towards increased NHS outsourcing.

The process of contracting out of NHS services started in 1983 but was effectively limited to catering, cleaning and facilities management until the NHS Plan in 2000…Since 2000, when the NHS Plan was launched by the Labour government, contracting out of services has expanded to include clinical services and pathology services. Later white papers have introduced competition into primary care and community health services.

Specifically, in 2000 the NHS created independent sector treatment centres (ISTCs) to contract out various clinical services. The same year, pathology and high technology diagnostic services began begin contracted out to provide-sector providers as well.

Further, in 2008, NHS began the Patient Choice initiative through which patients are able to choose any provider (i.e., NHS, private, not for profit) they wish for elective care.

Just as the U.S. healthcare system is not exclusively run by the private sector, in Great Britain the NHS also does not provide 100% of the care British patients receive.


  1. And, though it is often forgotten, general practitioners are private (organized essentially as small businesses), and contracted by the NHS.

    In fact, throughout the OECD, provision is often private, especially outside of hospitals.
    Even health systems which have historically relied on public provision have shifted in the past 20 years, partly through explicit policy action, partly spontaneously as more and more care is provided outside of hospitals (more often public) and provided instead in an outpatient/ ambulatory setting (as with tendering in England which you mention) which is typically private.
    Heinz Rothgang’s excellent 2010 book (The State and Healthcare) documents and assesses these trends. Here is a link to the intro

  2. While this post isn’t that protracted enough to basically explain the development of healthcare outsourcing in UK step by step, the main points are said well. I think the NHS sector has seen the value that outsourcing can add in their processes and production. Even less related jobs were outsourced – which was a good indicator that the concept of outsourcing has clearly helped them.

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