From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases

Abstract

Background: Different forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare. Main text: While in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services. Conclusions: Comparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one's local context: The failure of the Alzira model in Spain warns us of the problems of forprofit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.

Patient preferences and choices as a reflection of trust—A cluster analysis comparing postsurgical perceptions in a private and a public hospital

“…Another cluster that revealed a significant difference between the perceptions of men and women dealt with medical staff's commitment to patients, with significantly higher scores given by patients that had surgery at the public hospital (Table 2). This finding might be related to inherent differences in the interactions between the patient and the medical teams in the two healthcare systems 37 . For example, the presence of interns in the public health system may help in the communication between patients and medical staff in contrast to the private healthcare system, which does not train interns.…”

“…This finding might be related to inherent differences in the interactions between the patient and the medical teams in the two healthcare systems. 37 For example, the presence of interns in the public health system may help in the communication between patients and medical staff in contrast to the private healthcare system, which does not train interns. This finding is also in line with another study that pointed to patients' need for staff's commitment to establish trust in the medical team.…”

The role of public-private partnerships in extending public healthcare provision to irregular migrants: stopgap or foot in the door?

“…Eventually, PPPs are thus liable to expedite the erosion of public healthcare systems [16][17][18]. The risk of PPPs facilitating neoliberal welfare retrenchment has been described for the Israeli case [19,20]. Hence, in those cases in which PPPs emerge as stopgaps for public healthcare provision, they may undermine the concept of health as a universal and indivisible right, rather than help realize health rights.…”

A European arena for joint innovation in healthcare: The Platform for Innovation of Procurement and Procurement of Innovation (PiPPi)

“…Of course, it should be considered that diverse opinions on the appropriate balance of public vs. private spending exist ( 15 , 16 ), and in practice EU member states vary widely in total public expenditure as a percentage of GDP. In 2019, the public spending ratio ranged from over 50% in France, Belgium, and some of the Nordic countries, to ~35%+ in several Eastern European countries, to 32.8% in Switzerland, and 24.2% in Ireland ( 17 ).…”