Is the NHS underfunded? Three approaches to answering the question

The adequacy of funding for the National Health Service (NHS) is a perennial issue1,2 and one that has become particularly prominent in recent years.3 The way ‘underfunding’ is understood influences perceptions about how much resource is needed and where it ought to be channelled. This in turn has profound implications for patients, citizens and staff. In this article, we examine what it means to claim that health systems are underfunded and whether this applies to the contemporary NHS. We identify three main approaches to studying the issue and uncover the value judgements inherent in each approach. We argue that there is evidence to support the current claim of underfunding and conclude by suggesting future avenues for addressing this critical issue, both in the UK and elsewhere.