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Israel Journal of Health Policy Research

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Open Access 01-12-2020 | Integrative article

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

Authors: Dani Filc, Alon Rasooly, Nadav Davidovitch

Published in: Israel Journal of Health Policy Research | Issue 1/2020

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 for-profit 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.

Addressing the reasons for the apparently paradoxical transition to a universal system during a period of neoliberal reforms exceeds the scope of the present paper. For possible explanations, see [72].

However, unlike as in Spain, the system is open only for “legally” recognized residents.

It should be noted that supplementary insurance schemes sold by the public sick funds are community rated and have no underwriting (see, Chernichovsky 2013 [73]).

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Title: From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases
Authors: Dani Filc
Alon Rasooly
Nadav Davidovitch
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: Israel Journal of Health Policy Research / Issue 1/2020
Electronic ISSN: 2045-4015
DOI: https://doi.org/10.1186/s13584-020-00391-4

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

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