In the past half century spending on healthcare across virtually all countries—regardless of how they are funded and organised—has increased substantially. At approaching £1 in £10 of its economic wealth, in 2010 the UK devoted more than twice the share of its gross domestic product (GDP) to public plus private healthcare spending as it did in 1960.1

Some countries have seen spending rise much faster (fig 1⇓). The US spent around 5% of GDP on healthcare in 1960. Today it is nudging 18%, and in total the US spends almost the same on health as all other countries in the Organisation for Economic Cooperation and Development (OECD) put together. Germany, France, and the Netherlands now spend around €1 in €8 on healthcare. Millions of people around the world are employed in the labour intensive healthcare industry. Directly employed staff in the NHS account for around 1 in 25 of the working age population. How has all this happened and why? And where will it all end?