in countries where insurance is not mandated, there can be gaps in coverage—especially among disadvantaged and impoverished communities that can not afford private plans. the uk national health system creates excellent patient outcomes and mandates universal coverage but also suffers from large lag times for treatment. critics argue that reforms brought about by the health and social care act 2012 only proved to fragment the system, leading to high regulatory burden and long treatment delays. in his review of nhs leadership in 2015, sir stuart rose concluded that "the nhs is drowning in bureaucracy."