BIOETYKA / WPROWADZENIE

BIOETYKA / WPROWADZENIE - Przeglądy aktów prawnych

The Privatization of Health Care in Europe: An Eight-Country Analysis – Hans Maarse 2006

Introduction s. 3

This article adopts a comparative perspective by analyzing changes in the public-private mix in eight European countries. Four of them — Belgium, Germany, the Netherlands, and France — feature a social health insurance scheme in health care financing and a mix of public and private provider agents in health care provision. They belong to the category of the so-called Bismarck countries, named after German Chancellor Bismarck, who introduced social health insurance in the late nineteenth century. Three other countries selected — Denmark, Sweden, and the United Kingdom — finance health care mainly by tax resources. Hospital care in these countries is largely in the hands of public provider agents. Ambulatory care is provided by either public or private agents or a combination of both. These countries will be referred to as countries with a public health service model (the U.K. model is often referred to as the Beveridge model). The eighth country selected is Poland, which developed its own version of the public health service model — the so-called Semashko model — after it had become part of the Soviet-dominated part of Europe.

The Concept of Privatization s. 5

Whatever definition chosen, the concept of privatization always rests on a notion of public and private. The meaning of both concepts, however, is far from clear. In fact, various intellectual traditions exist in defining

public and private. Economists, for instance, tend to equate the public sector with the state2 and the private sector with the market. A sociological type of distinction between public and private is to associate private with private life and public with the world outside private life. Whereas private life is characterized by a high degree of closeness as expressed by the concept of privacy, public life features a high degree of openness. Sociologists do not associate public with the state and private with the market. These conceptualizations indicate that a single dividing line between public and private does not exist, but depends on the theoretical perspective taken (Starr 1982; Weintraub and Kumar 1997).

In this article, we follow a pragmatic approach by investigating privatization from four different perspectives: health care financing, health care provision, health care management and operations and, finally, health care investment.