Melting public-private boundaries in European health systems.
Renewed debates about the superiority of either predominantly public or predominantly private health services arrangements have tended to be more ideologically charged than conceptually precise. Historically, the public/private split in European systems has often been more sharply defined in principle than in practice. This real-world variation was further complicated during the 1990s by reforms that enabled publicly owned hospitals and health centres to manage their daily operations more independently. Most recently, several new initiatives have established complex cross-boundary arrangements that cannot easily be characterized as either public or private. This article presents a conceptually rigorous four-part classification of past public/private arrangements that can provide a theoretical baseline from which to judge future cross-boundary developments.
Saltman
Richard B
RB
Department of Health Policy and Management, The Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, Georgia 30322, USA. rsaltma@sph.emory.edu
D003695:Delivery of Health Care / Q000458:organization & administration*; D005060:Europe; D018166:Health Care Reform; D006291:Health Policy; D006754:Hospital Restructuring; D016304:Hospitals, Private / Q000458:organization & administration; D006779:Hospitals, Public / Q000458:organization & administration; D010067:Ownership; D011320:Primary Health Care / Q000458:organization & administration; D011332:Privatization; D011635:Public Health Administration; D013030:Spain; D013548:Sweden; D006113:United Kingdom