State Provision of Medical Services
Many countries have responded to the problem of market failure in the provision of medical services by going beyond regulation and the provision of state insurance schemes to the fullscale ‘nationalization’ of all their personal health services, i.e. state ownership of the plant and equipment (hospitals, etc.) and making all health service personnel employees of the state. The reasons for doing this are many and complex, and vary according to the particular history and culture of each country, but there is one common feature which is fundamental, namely the decision that willingness and ability to pay shall not be the primary criterion for determining access to medical care. There is invariably a strong egalitarian ethic present in such countries, but because this gets tempered by other objectives, actual performance seldom matches the system’s ethical pretensions. It is nevertheless useful for analytical purposes to sharpen up the issues by following through the logic of such a system to see where it leads, and what problems such a system would face if it did pursue the egalitarian ethic singlemindedly.
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