Alternative systems of health care provision

Rising costs of health care provision throughout the world have provoked a vigorous debate about the design of health care systems and the role of government in health care. In countries that have predominantly social provision, there are moves towards privatization and direct attempts to regulate prices. In more market-oriented systems, rising costs seem to be resulting in a greater uninsured problem and this too is provoking demands for reform. The authors discuss evidence from OECD countries from 1960 to 1990, then focus on more recent changes. Most OECD countries have chosen solutions where health care financing is socialized. The authors present a simple political economy model to describe the conditions under which this will arise. The authors expect to see increased reliance on market solutions and moves towards multi-tiered health systems that differentiate health care provisions made for different groups in society. -from Authors