to date the healthcare system centred on four health funds is widely acknowledged as providing a basket of universal services with good quality primary and secondary care while also accommodating demand for private health care however there are challenges and tensions in the system currently the authorities are having to rapidly expand the number of places in medical schools and nurse training because large cohorts of healthcare professionals are heading for retirement more broadly there are concerns that the core notion of a universal basket services is being eroded by copayments and the increasing demand for the additional services and options provided by private insurance