ABSTRACT
Chapter 20 suggested that public health service systems had better controlled cost inflation than other types of system. Conversely, it is often argued that they are ‘underfunded’, leading to more rationing of essential care and poor quality services. Evidence of any direct effects of rationing and service quality on health outcomes is hard to assemble. There are many factors determining health status, and these are not precisely understood. Furthermore, health status improvement is not the only valued outcome of a health system – others that may be considered important include freedom from anxiety, and comfort during illness. Palliative care may be valued for its own sake. Achievements of this sort should be added to health status improvement to reflect population satisfaction. Satisfaction levels may prove to be highly sensitive to levels of health system adequacy.
