Intended for healthcare professionals

Education And Debate

Role of private sector in United Kingdom healthcare systemCommentary: Cooperation should be based on what the public wants and needs from its healthcare system

BMJ 2000; 321 doi: (Published 02 September 2000) Cite this as: BMJ 2000;321:563
  1. Yvonne Doyle (, honorary senior clinical lecturer in public health medicinea,
  2. Adrian Bull, medical directorb
  1. a Guy's, Kings and St Thomas' Medical School, London SE1 9RT,
  2. b PPP Healthcare, Tunbridge Wells, Kent TN1 1BJ
  3. King's Fund, London W1M 0AN
  1. Correspondence to: Y Doyle, 21 Thorpewood Avenue, London SE26 4BU
  • Accepted 11 May 2000

Since 1948 the private sector has viewed itself as complementary to the NHS. Before the NHS was set up in 1948 health care was provided by charities and voluntary hospitals, private medical clubs, occupational medical services and works clubs, fee for service insurance, friendly societies, public medical services (which were funded by subscription), and medical fees paid on an ad hoc basis. The structured health insurance sector initially developed between 1940 and 1947 with the instigation of the London based Hospital Services Plan (now PPP Healthcare) and the amalgamation of several regional schemes into British United Provident Association (BUPA).

Summary points

Over 12 million people in the United Kingdom are covered for private health care

The private sector already provides many services for the NHS, such as psychiatric care and long term residential care for people with learning disabilities

The NHS provides many private beds

Collaboration between the NHS and private sector would provide a better health service than continued isolation

Structure of UK private healthcare sector

In 1997, over 12 million people were covered for medical expenses by insurers, friendly societies, and cash plan companies. Seven million people (12% of the population) were covered by private medical insurance. Care for this group, however, represents only 75% of acute medical and psychiatric inpatient and outpatient hospital treatment in the private sector. Some private care is self financed, and the NHS also contracts out to private providers—notably in the psychiatric services, care of elderly people, termination of pregnancy, and through waiting list initiatives.

Private medical insurance is more common among older people and those in social classes I-III, with coverage ranging from 22% for social class I to 2% for social class IV. The proportion of the population with private medical insurance also varies by geographical distribution; 20% of the population in the outer London metropolitan area are covered …

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