ABSTRACT
The various chapters in this book have brought out a number of points about health, health care, and social and economic policy. The primary focus has been on publicly and privately funded health care, funding constraints, the role of economics in meeting the needs of sick or injured individuals and the need for new institutional arrangements. What we know is that the total resources available to finance health care services are not infinite and that health care providers who think that more resources will be available through privatization and that markets will make the system more efficient, fail to understand or accept that a nation’s total resources have limits. Since health care is not a primary source of wealth creation, the financial limits are set by the wealth a region or nation produces and the societal demands on that wealth (Evans and Stoddart, 1990). Publicly financed systems striving to achieve equity in health services when a nation’s real wealth base is not growing, end up restricting the income growth of many health care providers and have difficulty introducing expensive new technologies. This is why two-tiering the system (private and public financing) allows some providers to gain a greater share of the pie while others will get less. It also changes the equity in the system since some patients will be unable to afford care or will have less than desirable service (Evans et al., 1996; Evans, Chapter 2 this volume).
