> In the UK, the NHS has the incentive to improve its operational efficiency that it simply gets told regularly "we're cutting X billions of your budget. Deal".

The trouble with this approach is that we've reached the point where they really can't deal and are consistently blowing through their budgets and talking about refusing non-urgent referrals for months at a time, and the government is just blaming them for overruning their budgets and punishing them with even more budget cuts.