There are a couple of models. In Germany it's provided by the State in the form of the regional Allgemeine Ortskrankenkassen ("general local health insurance fund"), but you can opt out and go fully private if you wish. In Switzerland it's provided by commercial companies who compete on price - but for the basic "social" package of services the law states they can only price based on ability to pay, not on risk etc, and they are prohibited from refusing insurance to anyone regardless of risk. What happens there is that companies compete not just on price and how exactly the basic service is delivered, but also on top-ups like cover for single rooms when in hospital, provision of non-essential out of hours care etc.  Some cheaper policies in CH require you to call a call centre similar to NHS Direct before visiting a GP or pharmacist, for example. This approach saves costs as it weeds out unnecessary visits - and in some cases they can move on from a nurse to a telephone doctor who can even make a prescription on some things where a visit really isn't necessary, or in some cases even refer straight to specialists where the problem is very clear-cut. I'd personally be happy to take such a policy even if it cost more - if it was cheaper, as it likely would be, that's a win-win. I think there is strong merit in both of them or indeed a hybrid of them in some form - e.g. most of the people who need out of hours non-essential care e.g. late evening or very early morning GP appointments are people like London commuters who tend to be earning a bit more yet need those services relatively occasionally due to being younger - so why not let them pay a higher insurance contribution or a fee for them? It's in a way like easyJet speedy boarding used to be - a perfect price differentiator - people either value it and pay for it, or think it's pointless and don't. It may well not be - it's one exception. But it depends whether you think that having children is a right or a privilege. I'd tend towards the latter (possibly the best privilege the world has ever known, and one that also comes with massive responsibilities that some parents sadly shirk), I think you perhaps tend towards the former - both are valid views and I don't seek to drag the discussion that way, rather I was just proposing an example. --- old post above --- --- new post below --- Mentioning "top-up" care...could an example of a top-up to the basic contract be thus: Basic, legally entitled NHS contract: you register with a GP within X distance of your home, and may see that GP between 8am and 5pm, Monday to Friday, except in the case of emergency care which would be available by some means 24/7 as at present. Enhanced options at a fee: the ability to visit any GP for non-emergency matters (e.g. one nearer work), visits between 6am-8am and 5pm-8pm or on Saturdays/Sundays where offered, etc etc etc. There are people willing to pay for this kind of service - so why not let them, and allow the NHS that extra money that they would voluntarily give to it?