75 Pivotal Public Policies: Britain’s National Health Service

Created by Britain’s National Health Service Act of 1946 and launched two years later in 1948, the National Health Service was the first universal healthcare system to be free of charge at the point of care.

Now the second largest single-payer healthcare system in the world after the Brazilian Sistema Unico de Saude, it actually consists of four separate health services covering the UK’s constituent parts of England, Scotland, Wales and Northern Ireland.

Its core principles at foundation were that it should meet the needs of everyone, be free at the point of delivery and be based on clinical need, not on ability to pay.


While the NHS operates constantly under cost pressures that make it a perennial political hot potato, none of Britain’s parties would dare propose switching to an alternative system.


Click here to see the complete list of 75 public policies that changed the world


Whilst leading the world in making world class healthcare readily available to the entire population, and inspiring similar approaches in countries such as Canada, other advanced economies have sometimes taken somewhat different approaches to delivering the same goal (such as through the use of insurance policies).

Many developing countries aspire to have their own equivalent to the NHS, but currently cannot afford it. Only the United States amongst the world’s richest countries spends far more of its GDP than Britain on health care without guaranteeing universal coverage.

The Patient Protection and Affordable Care Act of 2010, commonly referred to as “Obamacare”, together with the Health Care and Education Reconciliation Act of 2010 amendment, represents the most meaningful expansion of the coverage of the US healthcare system since the introduction of Medicare and Medicaid in 1965. But many Americans still rely on private health care insurance, or have none at all.

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