Turning the State back to its own hospitals

Compelling ministers and senior civil servants to use public hospitals is bold, disruptive and overdue. It strikes at the heart of a quiet contradiction: a state that funds world-class private care for a few while the majority depend on under-resourced public facilities. Globally, the idea is not without precedent. In the United Kingdom, politicians and senior officials rely on the National Health Service, which has historically forced constant political attention on public hospital performance. In Rwanda, political leaders and civil servants use the same public facilities supported by a national insurance system, reinforcing accountability and discipline in spending. Thailand’s universal health system similarly covers civil servants and the public through state-led schemes, helping sustain investment in public hospitals. The plan collapses the distance between policy and lived reality, creating direct pressure to fix broken infrastructure, stock medicines, retain staff and reduce waiting times. Money that currently subsidises private profits can be redirected towards theatres, equipment and ambulances. However, success hinges on safeguards. Funds must be ring-fenced, transparently tracked, and spent visibly on infrastructure and care — not absorbed by inefficiency.