The changing public/private mix in health care

Abstract

Five years after holding one of its first meetings on the subject, the European Health Policy Forum again took up the issue of the public/private mix in health care, this time co-sponsored by the World Health Organization. The deliberations during that first conference had to contend with the emotional defense of ideologies in addition to the factual issues, which were perhaps at the peak of concern among the policy-makers, providers and financiers of public health care in Europe. While the issues are still of concern, and without underestimating the problems uncovered, the discussions at this last conference, held in Brussels on 12 and 13 February 1987, emanated a feeling of greater ease in dealing with the subject. A significant part of the presentations and ensuing discussions centered on the examination of practical models of mixing public and private care within systems, and the development of sound relationships between the sectors rather than on opposing ideologies. Reflecting the ‘mix’ in the title of the meeting, the participants came from national bodies responsible for the delivery and planning of health care and non-profit health insurance, from academia and from the private sector. Before going over some of the extremely interesting and important issues and experiences presented, it may be useful to consider the current environment and how it was reflected at this Conference. Events in the intervening 5 years, although not really a long period of time, were probably responsible for this shift in emphasis and in tone. Three main trends occurred in this time first, private health care systems did not grow as fast as expected; second, economic problems within the public health services prodded us into examining management practices in the public and private sectors, in health as well as in other fields; and third, the problems of most European nations slow economic growth, more older citizens with more chronic conditions and more unemployed demonstrated the inability of