1) Public health spending in the UK rose faster in the 2000s than in previous decades, while growth of private spending slowed after 2007. The share of NHS-funded treatment provided by non-NHS providers also increased during this period. 2) Analysis of hip and knee replacements showed they increased substantially on the NHS between 2003-2012, with non-NHS providers responsible for over half of the rise. Some increase was due to demographics but there was also evidence of substitution from private to NHS funding. 3) Reforms opened up more NHS-funded care to non-NHS providers but the NHS remained the predominant provider, and further growth of non-NHS providers may be limited by NHS demand and