I don't think the NHS is a great example... things can surely be better than that. Incentives are a complicated issue in healthcare. In Australia there is a 't

I don't think the NHS is a great example... things can surely be better than that. Incentives are a complicated issue in healthcare. In Australia there is a 'two-tiered' system in the sense that there is a large public system funded federally and by states that provides access to anyone and everyone, and a private system where most people have private insurance and also pay additional fees. There is no insurance linked to employment. Primary care can be accessed for free or depending on where you live, often involves paying a gap for each visit. What doesn't happen is that all the best and most experienced doctors/nurses go and work in private. Almost all the doctors worth seeing work in the public system as well. Why? Well, it differs for each person but some combination of status, access to a professional network, collegiality, access infrastructure and expertise, job flexibility and the fact that it acts as a referral stream to 'take patients private'. The facilities in the public system are 'the best' becaue they still handle all the complicated and difficult care (Oncology, Transplants, Dialysis etc), despite what the private hospitals say in their brochures. My point is that if you make some adjustments, bake in some infrastructure funding, and make smart use of non-financial incentives, you can avoid creating a two-tiered system and build enduring capacity and quality in a single payer system.