Pluralism, public choice, and the state in the emerging paradigm in health systems.
Today in developed nations, the public pays for most medical care, with the state and the medical profession or providers determining its nature, form, and level. But there is no well-defined institutional framework for revealing consumer preferences and enabling client choice about the nature and form of public entitlement. This thwarts the efforts of health system reformers to satisfy their clients and consequently promote equity and control costs--the raison d'être of publicly supported care. Consumers can be empowered in the emerging paradigm, however, in which the publicly financed system also contains competing fund-holding institutions that organize and manage the consumption of care (OMCC), such as HMOs and sickness funds. In a system in which individuals are entitled to health coverage, OMCC institutions can play an essential role in both shaping the entitlement and in expressing members' preferences. To do this, the OMCCs need to be financed through capitation and endowed with appropriate constitutional rights on how to use the funds.
Chernichovsky
Dov
D
Department of Health Policy and Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel. dov@mail.bgu.ac.il
D002204:Capitation Fee; D003258:Consumer Behavior; D003363:Cost Control; D018864:Cultural Diversity; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D019049:Developed Countries; D005380:Financing, Government; D019981:Health Care Sector; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D015273:Insurance Selection Bias; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D017146:Models, Organizational; D011209:Power, Psychological; D017150:Public Sector / Q000191:economics; D011787:Quality of Health Care; D012941:Social Responsibility