Introduction

The way in which health systems are funded is often based on a series of political decisions which were made in the early development of different nations’ health systems, and yet, through processes of institutional reproduction, have remained remarkably intact today (Immergut, 1992b; Wilsford, 1995). As health systems absorb such substantial levels of resources, and because access to healthcare is not only recognised as a human right, but is also an international business of enormous scale, methods of healthcare funding in a particular country will be the result of a series of compromises between competing interests. Key stakeholders are those working in health services (with doctors usually having the most influence), government, public, private or not-for-profit providers of care, as well as other organisations such as insurance companies, patient representative groups and regulatory bodies. At election time the public will also have a say, but generally only from the ‘menu’ of options presented to them. Should events occur with particular salience to the general public (such as a rogue doctor or nurse, or a vulnerable person not receiving the right care), this can also mobilise change, especially should those events occur near an election.

This chapter explores the different configurations of the funding of health systems among the 11 countries included in the book, and the relationship between these configurations and access to healthcare, as well as a measure of the efficiency of the health system.

It therefore aims to discover whether there are patterns of healthcare funding that have necessary or sufficient relationships with healthcare access and measured efficiency, as well as whether there are any health systems which achieve both of these outcomes.

Healthcare funding

Healthcare is funded through a range of sources, but at the highest level of abstraction this involves a mix of money from the government, from health insurance of various kinds, or from the public through private, out-of-pocket payments. Government-funded health systems may utilise compulsory social health insurance as well as general taxation as their source of money. Health insurance can be public (where it can turn into a government scheme), or be organised on a private or not-for-profit basis.