This chapter examines international health-sector experiences in only a few respects. It deals mainly with the economic mechanism of health sectors in the OECD countries, which – excluding recent members such as the Czech Republic, Hungary, and Poland – have traditional capitalist, not post-socialist systems. (This is the group we mean when referring to the “developed countries” or “industrialized democracies.”) Unlike the discussion on p. 69, which classified the “menu” of institutional alternatives on an abstract plane, this chapter aims to identify, in a somewhat generalized way, some features of the economic mechanisms that actually operate.

The economic mechanisms in the industrialized democracies

Two important features of health-care systems are the form of ownership predominant among health-care organizations (on the supply side) and the predominant source of financing for health care (on the demand side). Table 4.1 surveys the ownership forms found in the health sector of the developed countries. The countries are grouped, beginning with those where the sector operates under state ownership and public financing, and ending with those where private ownership and private financing predominate. The various mixed and combined alternatives are in the middle.

The column headings use the term predominant. The real extremes of a purely state and a purely private-ownership system do not exist in practice. Everywhere there also appear forms decidedly different from the predominant one as well, although in many countries they have only a marginal effect.