Balancing Acts: Trends in the Public-Private Mix in Health Care

Abstract

Across the globe, health expenditures constitute a large and growing share of both public and private spending on social welfare. Levels of health spending vary widely between countries, reflecting pressures of different domestic economic circumstances, sociopolitical factors, demographic conditions, and the particular financing and organizational arrangements of national health care systems. Two major components of health expenditures are spending on personal health care (however its financing and delivery are arranged) and spending on population-level public health interventions. The need for these publicly financed, public health measures is presumed, even in the most market-oriented societies. Only governments can efficiently undertake collective measures on the scale needed to preserve population health for public health activities ranging from ensuring clean food and water supplies, to regulating the safety and efficacy of pharmaceutical products, to implementing population immunization programs and responding to epidemics, and the like (Gostin 2000; IOM 1988, 2003; WHO 2000).