Does this demonstrate that a primarily socialist national model of healthcare can be the most efficient and 'best' healthcare system? If so, what does this say about the belief in the 'efficiency of markets', presenting the optimal solution to public services?
Market efficiency in health care insurance (and health care is almost always paid for by an insurance model) is spoiled by a relatively little known problem called "adverse selection", in which optional health insurance does not lead to efficient allocation of costs/benefits but instead trends towards an outcome where health care costs those insured as much as it would if they were all the "sickest" people that they could be.
The most important determinant of whether this market failure manifests or not is not so much private (profit-driven) supply of service versus public, but whether health insurance is universal (which means compulsory) or optional.
Much provision of health services in England is actually profit driven (including GPs, hospitals, pharmaceuticals manufacture and sales). But entitlements are compulsorily provided and paid for by the population, whether they want it or not, and this overcomes the negative selection problem whereby healthy some people choose to forego insurance, and the remainder are charged as though they were all particularly unhealthy.
Under the NHS, a public body negotiates the cost of the services/goods provided, and it has for sure greater negotiating power than any private individual would. But it does not necessarily drive a hard bargain to lower those costs--GPs who negotiate their charges with this body are actually very highly paid (and of course they organise collectively to bargain from their side also). I don't think there is much evidence that big-pharma is screwed over by the public buyer--those companies seem to be doing nicely. I think the main area in which costs are kept low is the rate of pay of many directly employed NHS staff.
Not all health treatment is of course covered under the NHS. And co-payment is largely absent (ex prescriptions, and even then not all that many people pay for those). One downside of this is rationing, which does not mean "death panels" but does mean difficulty often in seeing one's GP and near impossibility of--for example--seeing an NHS funded dentist. In several European countries (with universal health systems) you pay something (not the true cost) to see a GP, and my impression (which is anecdotal) is that even a small amount increases the availability of appointments due to the disincentive for completely frivolous doctor's visits and no-shows. £10 seems a little too high in this regard. But for the NHS to introduce a GP fee (with a bundle of exemptions no doubt) would be a good thing in my book.
The NHS system is somewhat less flexible than other European systems as well in that it is not really possible to "add on" extra cover without taking out a private deal on top, which will typically cost a four figure sum and contain duplication and/or more than many people might want. In some countries I think you can select what you buy to a greater extent, although there are obviously statutory minimum entitlements/requirements. This aspect does not appear to have been scored in the survey.
