ABSTRACT
Chapter ten looks internationally at countries that have low-cost, high outcomes in health care. The common feature of these countries is a relatively high level of out-of-pocket spending on health care. This substitutes autonomous choices by millions of consumers for decisions by governments and managerial third-party payers. The result is more prudent decision-making that encourages health innovation and productivity, less paperwork and greater clinical output. Public spending on health care reflects a more general perverse paradox of big government: when the state seeks to make goods affordable, the result is goods that are more expensive rather than less costly. This is because the state, and third-party payers generally, are not efficient allocators of resources, as opposed to decentralized autopoietic markets and industries.
