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The Public-Private Mix in the Modern Health Care System - Concepts, Issues, and Policy Options Revisited

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  • Dov Chernichovsky

Abstract

Private financing of care can make universal entitlement to care more comprehensive' and complete.' The possible combination -- at the point of service provision -- of privately acquired entitlement with the public entitlement, can impinge, however, upon the goals (e.g. improved health, equity, cost containment, care production efficiency, and client satisfaction from service) of the publicly supported health system. The potential to achieve these goals is at greatest risk in the combined system' (e.g., Australia) where, contrary to the segregated system' (e.g., Canada), the same providers are sanctioned to provide medical care under both private and public contracts. A combined system may be inevitable, however, for both economic and political reasons, especially where medical resources are relatively scarce. In this case, the Emerging Paradigm in health systems can offer the best possible solution to the public-private mix issue. In this paradigm, budget-holding institutions, intermediaries between financing entities and providers, organize and manage the consumption of care (OMCC) under public entitlement. The OMCC institutions can offer private insurance, to supplement to the public insurance', but supervise separate groups of providers, those working under public contracts and those working under private.

Suggested Citation

  • Dov Chernichovsky, 2000. "The Public-Private Mix in the Modern Health Care System - Concepts, Issues, and Policy Options Revisited," NBER Working Papers 7881, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:7881 Note: HE
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    1. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, January.
    2. Chernichovsky, Dov, 1995. "What can developing economies learn from health system reforms of developed economies?," Health Policy, Elsevier, vol. 32(1-3), pages 79-91.
    3. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
    4. Wagstaff, Adam & van Doorslaer, Eddy, 1992. "Equity in the finance of health care: Some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 361-387, December.
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    Cited by:

    1. Dov Chernichovsky & Sara Markowitz, 2001. "Toward a Framework for Improving Health Care Financing for an Aging Population: The Case of Israel," NBER Working Papers 8415, National Bureau of Economic Research, Inc.
    2. Dov Chernichovsky & Arkady Bolotin & David Leeuw, 2003. "A fuzzy logic approach toward solving the analytic enigma of health system financing," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 4(3), pages 158-175, September.
    3. Dov Chernichovsky, 2001. "A Fuzzy Logic Approach Toward Solving the Analytic Maze of Health System Financing," NBER Working Papers 8470, National Bureau of Economic Research, Inc.
    4. Marcelin Joanis & David Boisclair & Claude Montmarquette, 2004. "La santé au Québec : des options pour financer la croissance," CIRANO Project Reports 2004rp-04, CIRANO.

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