ABSTRACT
Equitable access to health care is an objective of many health care systems (Mooney et al. 1991). Policies aimed at extending coverage of health insurance or publicly funded health care provision to broader (or entire) populations are often a central part of health care reforms aimed at promoting equitable access to care. Removing price as the mechanism for allocating health care among competing demands increases the demand for care. Adopting need for care as the means of allocating health care resources instead of price combines concerns about equitable access to care (those with greater needs receive greater priority) with concerns about efcient resource use (maximizing expected health gain from available resources). Moreover, under universal public health care programmes governments are the sole (or major) purchaser of health care and hence in principle can use their monopsony power as a way of managing and controlling the costs of health care. However, in practice there is no evidence to suggest that publicly funded health care systems per se are any more successful at controlling health care costs than health care systems with a greater involvement of private nancing. For example, based on OECD gures (OECD 2011), the rate of increase in the proportion of gross domestic product (GDP) spent on health care over the period 1989-2009 was greater in the UK (with a predominantly publicly funded system) than in the US (with a predominantly privately funded system). Yet other countries with predominantly publicly funded systems, such as Sweden and Canada, had lower rates of increase than either the UK or the US over the same period. In all these countries, health care continued to absorb an increasing proportion of what was, in the case of most countries, an increasing GDP. Hence, the type of health care system, although determining who has access to care, has little inuence on cost control per se.
