Are single payer systems better prepared to deal with COVID-19?

In theory, single payer systems are the best approach to deal with existential threats or pandemics. The strengths of single-payer, top-down approaches are that having most funds–and potentially most workers–within a single entity can lower coordination cost and lead to a more effective response. The key drawback of single payer, top-down systems is they typically are less good at dealing with the complexities of care. For instance, if guidelines for patients with diabetes say treat patients with high-value treatment X, that may actually not be appropriate for a given patient with other commodities, allergies, treatment preferences, etc. In the case of a pandemic, however, addressing these more complex cases is less important than focusing efforts on addressing the pandemic-related issues. An article in the Economist summarizes conventional wisdom as follows:

“There are many disadvantages to centrally organising a health-care system for 60m -plus people,” says Helen Buckingham of the Nuffield Trust, a health think-tank. “An advantage is that, when you need to do command-and-control, you can, and you can do it quickly.”

So while you may or may not like single payer, a single payer like NHS is best for addressing a pandemic…right? Well perhaps not. On the one hand, an article in the Economist stated that Britain’s National Health Service may be among the best prepared countries for a pandemic due to its testing infrastructure and contingency planning.

On the other hand, NHS may struggle to meet treatment needs in practice. Emergency department visits have long waits, vacancies are high, and infrastructure capacity is low. For instance, as of January, only 82% of people requiring an emergency department visit were seen within 4 hours.   The Economist reports that there were 100,000 job vacancies not yet filled across NHS. The article continues:

Alison Pittard, dean of the Faculty of Intensive Care Medicine, notes that Britain has historically spent relatively little on intensive care. It has fewer beds than other countries in Europe, with just 4,048 in England, of which three-quarters are already full.

In short, addressing a pandemic is not as simple as having a single-payer vs. non single-payer system. Fighting COVID-19 requires a multi-faceted, coordinated regardless of what health care system one is in.


  1. Interesting! I think that with this coronavirus everyone is crazy. Many more people are scoring for cancer or diabetes around the world. For some reason this time – everyone decided to make a real “apocalypse”, I do not want to offend anyone – this is just my opinion. Now quarantine is everywhere, and the situation with a single-payer system is not clear. I have a question, why so far we were not ready for this? I think this is slight negligence of the government. Indeed, in the world, I’m not sure, there are a lot of all biological weapons … Good luck!

  2. Single-payer is no cure-all, but all other things being equal it functions better. Poor funding and planning is a function of many governments and is independent of Form of Healthcare delivery.

  3. Single-payer is no cure-all, but all other things being equal it functions better. Poor funding and planning is a function of many governments and is independent of health care delivery system.

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