Melting public-private boundaries in European health systems

• DOI: 10.1093/eurpub/13.1.24
• Publication Date: 2004-11-11T16:00:11Z
• Authors: R. B. Saltman
• Keywords: Sweden; Primary Health Care; Hospitals, Public; Health Policy; Ownership; Privatization; United Kingdom; Hospitals, Private; 3. Good health; Europe; 03 medical and health sciences; 0302 clinical medicine; Spain; Health Care Reform; Hospital Restructuring; 0305 other medical science; Delivery of Health Care; Public Health Administration

Renewed debates about the superiority of either predominantly public or predominantly private health services arrangements have tended to be more ideologically charged than conceptually precise. Historically, the public/private split in European systems has often been more sharply defined in principle than in practice. This real-world variation was further complicated during the 1990s by reforms that enabled publicly owned hospitals and health centres to manage their daily operations more independently. Most recently, several new initiatives have established complex cross-boundary arrangements that cannot easily be characterized as either public or private. This article presents a conceptually rigorous four-part classification of past public/private arrangements that can provide a theoretical baseline from which to judge future cross-boundary developments.