The Changing Role of the State in Healthcare Service Provision

Abstract

This chapter focuses on measuring the public/private-mix of service provision in order to evaluate the nature of the role the state adopts as a provider of healthcare services and how this role has changed over time. While internationally comparable time series on healthcare financing give a clear indication of the role of public relative to private financing, there is no such common standard for the service provision dimension. The absence of a straightforward indicator for measuring the public/private-mix of healthcare delivery might be one reason why the role of the state in service provision has only been poorly scrutinized (Wendt et al. 2005). However, a number of studies have concentrated on the relation between the state and healthcare providers (Frenk and Donabedian 1987; Moran 1999; 2000) and also on the question of ownership of healthcare provision (Moran 1999; 2000; OECD 1987b). However, these studies have not provided empirical evidence on the level of public service provision in cross-country comparison (Powell 2007; Wendt et al. 2009), nor have they treated service provision as a distinct dimension separate of financing and regulation.