The National Health Service is famous for being free at the point of need, but analysts say that if the 60-year-old NHS is to serve an ageing and expanding population, the reality of its cost must be accepted.

The anniversary of the NHS, launched on July 5, 1948 by then Labour Health Minister Aneurin Bevan as a cradle-to-grave system, has prompted an avalanche of reviews and studies into its - and the nation's - future health.

Views vary on how to provide the best service for the NHS's 60 million users, but analysts agree on one point: Britain's public and its politicians must accept that the cost of the world's largest publicly funded health service is going up, and acknowledge it is a luxury, albeit one this society can afford.

"We have become fixed on the idea that the NHS is somehow free," David Furness, a health service analyst at the Social Market Foundation think-tank, told Reuters.

"It is not free. We all pay for it through taxation, and it's free at the point of use - that's something quite different. There are no blank cheques, but we should be celebrating the fact that our health system can give so much more than anyone ever imagined it would in 1948."

In terms of sheer size of personnel, only China's People's Liberation Army, America's giant Wal-Mart supermarket chain and India's enormous railway system compare with the NHS.

With a workforce of 1.5 million people across Britain, it is Europe's largest employer, and it deals with eight patients every second.

Analysts say a reluctance to recognise the costs of the NHS leads to a lack of realism when it comes to discussing reforms or possible limits on what it can and should provide.

The state of the NHS, seen as the crown jewel of Britain's welfare state, is intensely political. Waiting lists for operations, waiting times in emergency rooms, and working conditions for medical staff all pop up regularly as campaigning issues ahead of elections.

During more than a decade in power, Prime Minister Gordon Brown's Labour Party has increased spending on health care dramatically, but his opponents say he and predecessor Tony Blair did not go far enough to change how the system is run.

PLANS FOR CHANGE

A major government-commissioned review by Health Minister Ara Darzi, published this week, said the NHS of the future should focus more on the quality of care, not on quantitative targets like cutting waiting times, or waiting lists.

That shift was good news for many in the medical profession.

"We welcome the general tenor of Lord Darzi's report that the future emphasis should be on the whole patient/client experience in the NHS - from the quality of the consultants' care to the standard of the food - rather than the crude managerial targets of recent times," said Karen Reay, health officer for trade union Unite.

But as the King's Fund health care think-tank pointed out, the 140-page report had "two significant omissions".

"There are no estimates of how much all this will cost and no indication of just how different the government expects the quality of health services to be in five or 10 years time," said Niall Dickson, the Fund's chief executive.

The review was slammed by the Conservatives, which is riding high in the polls as Brown's popularity slides.

"The complete lack of vision in these proposals means that, sadly, the government has missed its 'once-in-a-generation opportunity' to enact the real reform that our NHS needs," said Conservative Health Spokesman Andrew Lansley.

Conservative leader David Cameron has said he wants his party - the party of Margaret Thatcher and Winston Churchill - to "replace Labour as the party of the NHS".

He has criticised Labour's handling of the national health provider, saying a Tory government would ensure "medical professionals recover their professional freedom".

But analysts say the Conservatives have yet to offer coherent policies on public services, and must prove themselves if they are to win the next election, which is due by May 2010.

PATIENTS AND POLITICS

The political wrangling that accompanies almost every mention of reform for the health service, as well as a predicted economic downturn, could stall improvements and development. Some analysts say the fact that the NHS is funded by taxpayers, or voters, means it is always going to be a political football.

"Funding through income tax means inevitably that the NHS is intensely politicized and run by politicians," said Richard Smith, a heart and lung specialist who wrote a commentary on the NHS in the Journal of the Royal Medical Society.

"And politicians have a time horizon that is far too short for the systematic improvement that a health system needs."

When the NHS was launched in 1948, it had a budget of 437 million pounds - a figure that has now ballooned to more than 90 billion pounds last year.

According to a crude calculation by the government's department for health, that NHS budget equates to spending 1,500 pounds for every man, woman and child in the UK.

The government has pledged to increase this budget by around 4 percent in real terms in the coming years - bringing total spending to around 110 billion pounds by 2010/2011.

But Britain's population is getting bigger, and older, with some projections cited by the King's Fund suggesting that by 2066 the NHS's 60 million users will have become 82 million, and more than 25 percent of them will be over 65 years old.

The rise in demand - to cater for an ageing population, their rising expectations for healthy lives, and for expensive new drugs and technologies - means Britons must shift their thinking on the NHS and be open about the cost, analysts say.

International comparisons between health-care systems are notoriously difficult, but in broad terms, the NHS is often viewed negatively in comparison with France's system of social insurance, and as a picture of perfection in comparison with the U.S. system, funded largely by private medical insurance.

John Appleby, a health economist at the King's Fund, cites a 2000 study by the World Health Organisation which ranked the NHS 18th out of the 191 health-care systems analysed.

France came top, and the U.S. health system, which then spent a higher portion of its gross domestic product on health than any other country, came 37th.

Oscar-winning director Michael Moore memorably compared the two in his 2007 documentary "SiCKO", which details the painful stories of Americans who say they were denied life-saving treatment by insurers or forced to forgo emergency treatment at hospitals because they could not afford to pay.

As counterpoints, Moore toured Canada, Britain and France and feigns amazement when confronted with evidence that those national health-care systems provide better basic care.

That comparison rings true to many in Britain.

"To us in Britain, the United States is a failure standard - if you are poor, you really get very bad health care," said Furness. "But we are right at the other end of the scale. We try to pretend the issue of money in health care doesn't even exist."