Pluralism, public choice, and the state in the emerging paradigm in health systems.

Full Abstract

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.

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Author information

Author/s: Chernichovsky, Dov (D);

Affiliation: Department of Health Policy and Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84105, Israel. dov(-atsign-)mail.bgu.ac.il

Journal and publication information

Publication Type: Journal Article

Journal: The Milbank quarterly (Milbank Q), published in United States. (Language: eng)

Reference: 2002-; vol 80 (issue 1) : pp 5-39

Dates: Created 2002/04/05; Completed 2002/04/18; Revised 2004/11/17;

PMID: 11933794, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Capitation Fee
Consumer Satisfaction
Cost Control
Cultural Diversity
Delivery of Health Care - economics; organization & administration; standards
Developed Countries
Financing, Government
Health Care Sector
Health Expenditures

Health Services Accessibility
Humans
Insurance Selection Bias
Managed Care Programs - economics; organization & administration
Models, Organizational
Power (Psychology)
Public Sector - economics
Quality of Health Care
Social Responsibility

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