Private healthcare has been one of the few winners in the pandemic.

Record numbers of people are taking out private medical insurance or dipping into their own pockets to pay for operations such as cataracts, knee replacements and hernia repairs amid huge NHS backlogs.

In Scotland, a total of 4,960 people were admitted to private hospitals on a "self-pay" basis between January and March this year - meaning that they were covering the full cost personally. That compares to 2,850 in January-March 2019 - an increase of 74%.

For someone undergoing a hip replacement, the price tag is around £12,500.

READ MORE: Private healthcare admissions rising faster in Scotland than rest of UK 

UK-wide, the number of private procedures covered by medical insurance plans has climbed to record levels, with Scotland seeing the largest year-on-year increase - 23% - to 6,255 in the first three months of this year.

Two-tier healthcare has always existed in the UK, but it is accelerating.

The Herald: Insured and Self-Pay Admissions to private sectorInsured and Self-Pay Admissions to private sector (Image: Private Healthcare Information Network)

Covid contributed in two ways: firstly because it caused (and continues to cause) major disruption to elective care, and secondly because of the way it polarised incomes.

Households which were already better off - in jobs where they could work from home - were more likely than, for example, retail workers or carers, to have accumulated savings during lockdown which could then fund private healthcare.

It is no surprise that people who can afford to are jumping the queue.

In summer 2022, the Scottish Government pledged that 18-month waits for inpatient/day case procedures on the NHS would be all but eliminated by the end of September 2023.

That ambition appears to have been quietly dropped: by the end of June this year there were still 17,201 waits in excess of 18 months on the lists, of which 6,831 exceeded two years and 1,581 three years.

The NHS can, and does, use the private sector - but this has always been more sparing north of the border.

In 2021, for example, Scotland spent 0.5% of its health budget sending patients for private treatment compared to 7% by NHS England.

Of the 4,600 hip and knee replacements and repairs performed in the private sector in Scotland in 2022, roughly 250 were NHS patients.

The UK Government is now in the midst of a major drive to clear waiting lists by ramping up NHS referrals into the private sector in England.

READ MORE: Is the rise and rise of two-tier healthcare now inevitable? 

Should Scotland be doing the same?

One risk is that this simply destabilises the NHS by drawing both funds and consultants away. Most doctors working in the private sector are also NHS employees.

At present, the number of consultants working in the private sector in the UK is around 9000 - back to levels last seen in early 2019 - but what is unclear is how they are splitting their time.

The second is problem safety. If something goes wrong, only the NHS has the facilities to provide emergency or intensive care.