Alternative Systems of Health Care Provision
分析全球医疗成本上升背景下，公共与市场导向医疗体系的优劣，基于OECD国家1960-1990年数据及近期变化，提出一个政治经济学模型解释社会化融资的条件，并讨论多层级医疗体系的趋势。
Health care Timothy Besley and Miguel Gouveia Rising costs of health care provision throughout the world have provoked a vigorous debate about the design of health care systems and the role of government in health care. In countries that have predominantly social provision, there are moves towards privatization and direct attempts to regulate prices. In more market-oriented systems, rising costs seem to be resulting in a greater uninsured problem and this too is provoking demands for reform. Technological change will put constant pressure on health care systems (public or private), generating serious social choice problems. However, this must be seen in the context of a traditional commitment to providing a non-trivial minimum level of health care to all members of society. We discuss evidence from OECD countries from 1960 to 1990, then focus on more recent changes. The central problems of market-oriented systems are cost containment and the fact that significant segments of the population go uninsured. Most OECD countries have therefore chosen solutions where health care financing is socialized. We present a simple political economy model to describe the conditions under which this will arise. The hallmark of public provision is relative uniformity in access to health care. This creates incentives for individuals to opt out of the public sector and to supplement what they can obtain through the state. In addition, it creates a significant commitment to redistribution through public provision. Rising costs strain the generosity of taxpayers. We expect to see increased reliance on market solutions and moves towards multi-tiered health systems that differentiate health care provisions made for different groups in society.