Choice and competition in publicly funded health care

摘要

There are four basic models of health service delivery: those that rely on trust, on command and control, on voice, and on choice and competition. All have their merits and demerits; but there are both theoretical and empirical arguments for preferring choice and competition in many situations. However, the relevant policies do have to be properly designed. Many countries where health care is funded from the public purse, face severe problems with their systems of care delivery. Public funding is often accompanied by public delivery; that is, by hospital and other medical facilities owned and operated by the state. Although, on occasion, such institutions can work successfully, in many other cases they do not. In fact, typically, they provide low-quality care, are inefficient in their use of resources, and are unresponsive to the needs and wants of their patients. In addition, they are usually close to monopolies with patients having relatively little alternative sources of treatment - especially if they are poor and cannot afford whatever private facilities may be available. They are also often directly funded from government, with budgets that are determined historically and that bear little relationship to their performance or activities.