ABSTRACT
Introduction Since the publication of the first Nuffield volume on The Public-Private Mix for Health over 20 years ago,1 healthcare systems have experienced significant increases in funding and many well-intentioned reforms, both structural and financial. Despite these activities, much is unchanged in European, North American and Antipodean healthcare. Acrimonious debates continue as to the level and distribution between income groups of the funding of healthcare. While vague agreement exists about the need to improve the efficiency of healthcare provision with better performance management and market-like incentive structures, there is a lack of clarity concerning the goals of such innovations and a failure to evaluate outcomes systematically in all the countries that have experimented in this way. These omissions are, in part, a product of ideological debate and in part of the public and private reformers' unwillingness to address fundamental inefficiencies that reflect international medical practice.
