This article is written by Michela Robino, a WES 2025 student journalist and writer for The Stork.
Few moments in recent history have tested the resilience of healthcare systems as much as the COVID-19 pandemic has. The crisis exposed flaws in both fully public and private healthcare models, reviving the debate over their respective roles. It also shed light on the existence of hybrid systems, where public and private sectors collaborate to various extents, raising questions about the most effective balance. This was the central issue discussed with the healthcare panel, at the Warwick Economic Summit 2025.
The UK’s healthcare model is based on a “two tier system”, where 95% of the healthcare sector is dominated by the National Healthcare System (NHS) through taxation, and the rest is backed by the private sector, as described by Nora Colton, director at UCL Global Business School for Health. The key question explored in this debate was whether the private sector complemented or undermined public healthcare, not just in the UK’s model, but globally. The impact of the pandemic further highlighted this discussion as a crucial matter.
A Two-Tier System
David Rowland, Director for the Centre for Health, and the Public Interest, emphasized that the fundamental mission of public healthcare (NHS) is to be equitable, and enable accessible care for all “based on need rather than wealth”. Thus the NHS provides free healthcare at the point of use for UK residents. The NHS is able to function thanks to taxation by the general public and National Insurance contributions,. The two-tier system implements the private sector as a supplement to the NHS, focusing on elective procedures, such as hip replacements (example given in the discussion), but relies heavily on NHS-trained doctors, practitioners and infrastructure. However, before the pandemic arrived, the NHS was already under strain. Austerity measures implemented from 2010 onward slowed NHS funding growth, leading to outdated infrastructure, and long waiting times. Following Brexit, matters only worsened, with the UK having one of the lowest doctor-to-patient ratios in Europe due to understaffing.
Under the unpredictable weight of the pandemic, coupled with the government’s unpreparedness, the NHS completely struggled to meet its fundamental mission. Meanwhile, the private sector, with its wealth and infrastructure, was underutilized. By January 2021, the NHS was at a breaking point, handling testing, PPE (personal protective equipment) shortages and delays, which contributed to higher transmission rates and hospital overloads. About 1,000 deaths per day were recorded, making it one of the highest COVID-19 death rates in Europe. Despite being highly respected, the NHS was alarmingly underfunded and overburdened at this stage, leading to ICU shortages, delayed treatments, and an overwhelmed workforce.
It is also important to note that at the time, the UK government was under Boris Johnson, who was initially quite slow to act in January 2020 and even considered “herd immunity” as a solution– a strategy widely criticised as reckless and uninformed. Unfortunately, this hesitation cost the UK thousands of lives and a complete breakdown in healthcare capacity for the NHS. The subsequent solution was to outsource pandemic responses to the private sector, investing £37 billion in a test and trace system, and involve inexperienced companies, both of which failed.
Lessons From Other Models
One of the key examples given during the discussion was the more balanced public-private integration of Germany. Germany operates with a dual insurance system, where everyone has public coverage, but individuals can opt for private insurance as well. Thanks to this dynamic system, it is simpler to scale resources during emergencies, for instance, the pandemic, since private hospitals are more efficiently connected with the public sector.
Generally, when it came to the worldwide healthcare crisis, Germany was able to better manage the early and mid-stages. According to cumulative data from April 5 2024, Germany totaled 38.8 million cases and 183,027 deaths in comparison to 24.9 million cases and 232,112 deaths identified in the UK. Thanks to better preventative measures such as rolling out mass testing much earlier than the UK, by March 2020, Germany had one of the highest testing capacities in Europe. Additionally, thanks to the dual insurance model, the allocation of resources was efficient, with higher ICU capacity: 33.9 ICU beds per 100,000 people.
In contrast, the US is a prime example of private healthcare being the dominant sector, resulting in wide disparities in accessibility between the lower and middle classes. The pandemic only amplified this inequality, skyrocketing death rates. Millions of uninsured Americans were left without critical care.
A clear example of the consequences of a privatised healthcare system can be observed with the recent case of Luigi Mangione. Mangione made the headlines for uninsured patients being denied urgent treatment due to their inability to pay. His story became emblematic of the harsh realities of a system where healthcare is a privilege, not a right. Unlike the UK’s NHS, which guarantees care based on need, the U.S. model prioritizes those who can afford private insurance. As a result, many Americans delayed seeking help during the pandemic, while others faced crippling medical debt after hospitalization.
Possible Solutions: The Right Mix
After a brief outlook of these two systems, The UK government and the NHS could certainly take note of both failures and successes, especially Germany’s. During the summit, the panel emphasized that there should be a cohesive and regulated collaboration between both the private and the public sector, since neither can stand alone, especially in the face of a pandemic. The core/essential takeaway from the panel discussion is that healthcare should be recognized as a fundamental right, not a privilege. Public healthcare on its own may seem equitable, but it encounters the problem of limited funding and lack of innovation due to reliance on the taxation system. Private on the other hand, may guarantee faster treatment but completely disregards healthcare as a right, leveraging inequality. Both extremes aren’t functional in practice.
Global Application
A regulated hybrid model combining accessibility from the public, and innovation from the private sector may be a better solution for the UK, but may also be applicable globally. Naturally, this model also comes with its faults and risks, such as the influence of the private sector, which can impact how funding is allocated across different services. This strategic middle-ground would require careful government regulation, a shift in ideological debates and pragmatic solutions. Healthcare crises such as the pandemic were wake-up calls for healthcare systems to put both political and administrative differences aside and collaborate for the greater good.
The views and opinions expressed in this article belong solely to the writer and do not necessarily reflect the views and opinions of the Warwick Economics Summit.
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