On the Fuzzy Boundaries between Public and Private in Health Care Organization and Funding Systems

The paper proposes a survey of health care organization and funding systems in order to underline and discuss, in this specific field of social assistance, the combination public versus private provision and production of services. The survey then examines the present features of various National health services focusing on the efficiency and equity of public intervention and on the industrial organization of the institutional design of health care. In this context, it treats the rationale of cost-benefit of vertical integration of structures, devoted respectively to purchasing and providing health care services. Further, the paper considers the advantages and disadvantages of managed competition in quasi-markets and, finally, it deals with insurance systems, social as well private and supplementary ones. From the survey it turns out that the main distinctions of health care regimes in industrialised countries are not in terms of private versus public ownership of providers, rather in terms of industrial organization setting and in terms of the proportion of public versus private expenditure.