ABSTRACT
A health system is made up of users, payers, providers and regulators, and can be defined by the relations between them. Governments can play a number of different roles as financers, regulators and/or providers of services. In some health systems the government is the dominant actor, providing and financing most services. Tax revenues pay for building and equipping facilities for service provision, for employment of the people who work within them, and the supply of drugs and other non-durable inputs. Patients receive services free at the time they use them. Some countries have even outlawed private practice, although it is doubtful that it has ever anywhere been possible to prevent all private transactions involving health related services or commodities. At the other extreme, government can be a more minor actor, although there is always some government subsidy or tax on components of the health system, regulation of some service transaction (such as minimum standards for the qualification ‘medical doctor’ or for hospitals) or public ownership or employment of some of the resources used to produce health services. Particular components or sub-systems, within a national system, can have almost wholly public or private characteristics. For example, public services may involve no private transactions at all, and some sectors, for example unregulated pharmaceutical markets, can operate entirely without government intervention. It is probably the case though, that even at the sub-system level, purity of public or private characteristics is rare – mixtures of public and private characteristics are the norm.
