How is public health service performance related to institutional arrangements in OECD countries?

Abstract

This study compares the institutional arrangements and performance of the public health services in 30 OECD countries using a fuzzy-set ideal-type analysis and Fs/QCA. Three dimensions of the institutional arrangements have been selected to empirically classify the public health service systems: (1) the ways in which financial resources are created, (2) the extent to which consumers can choose service providers, and (3) the extent to which the government regulates public health service providers in terms of service price, operational procedures, and facilities. The fuzzy-set ideal-type analysis results in eight categories of public health service systems on the basis of their institutional arrangements. This fuzzy-set ideal typology is richer in detail to characterize institutional arrangements for public health services, while at the same time largely embracing the existing theoretical categorizations of the public health service systems of the OECD countries. The Fs/QCA has identified conjunctural sufficient conditions to explain the performance of the public health service systems. Hence, the results of the analysis provide several policy implications. For example, there can be multiple paths to longer life expectancy in higher income countries. One such path is to have national health insurance while allowing more choices for health service providers. Another path is to effectively regulate the prices of medicine and medical services, while not intervening in health insurance and service provider issues.