Privatisation in Western European Health Care: a comparative study

Since the mid 1970's many countries have at­tempted to develop a strategy for controlling the ratio of growth of public spending. In this strategy privatisation is used as a general in­strument for healing public finance. This paper describes the different types of privatisation in health care which are possible. Further we will analyse in a more quantitative way to what extent privatisation is used in 4 European countries. These countries are the Federal Re­public of Germany, The Netherlands, both representatives of social security based health care systems, and the United Kingdom and Italy, as representatives of countries with a National Health Service. The development of the public health expenditures as a percentage of total health expenditures is related to the development of the total health expenditures as a proportion of the gross domestic product for each country. It is concluded that pri­vatisation is in general of limited importance in health care. Cost sharing at the demand side and contracting out at the supply side are the most used types of privatisation. We expect that self-governance will increasingly become a public management tool for healing public health care spending.