Public funding predominantly from taxation or social insurance.

1. SUMMARY OF HEALTHCARE SYSTEM INFLUENCES ON PATIENTS’ EXPERIENCES 5000 Healthcare system structure, financing, competition and choice Patient incentives (demand side cost sharing) 4000 3000 Total health expenditure 2000 1000 0 Patient expenditure as percentage of total health expenditure 2001 Italy Spain Ireland Finland Iceland Austria Belgium France Canada Denmark Norway Australia Sweden Germany Netherlands Luxembourg Switzerland United States New Zealand United Kingdom 35 Public expenditure on health Private expenditure on health 30 In highest health care spending OECD countries where data are available. Expenditures per capita US $ PPP 2001. 25 20 15 10 5 0 Italy Spain Ireland Finland Iceland Provider incentives (supply side) France • Provider activity and behavior • treatment setting, type, duration • multidiscipline team • use of technology Austria Canada Denmark Norway Australia Germany PATIENTS’ EXPERIENCES Netherlands Switzerland United States New Zealand OECD countries are included where data are available Doctor payment Hospital and capital provision Provider payment / supply side incentives have been found to be more powerful than demand side incentives [1] because information asymmetry gives providers a powerful influence over demand. [4] FINANCING OF HEALTHCARE SYSTEMS use different blends of public and private funds. • DIRECT PAYMENTS BY PATIENTS: • (Demand side cost sharing) • co-payments or deductibles associated with insurance • • full payments for non-insured services [8] Public funding predominantly from taxation or social insurance. • Tax based (Beveridge) systems may use revenue from general or hypothecated taxes. • Social insurance (Bismarck) may be based on income or employment; may comprise competing insurers. Demand side cost sharing may • reduce health care utilization unless people with low incomes are protected • empower patients Private expenditures private medical insurance (PMI out-of-pocket payments) significant in many countries PMI may be: • substitute for public scheme • complement to cover “gaps” in public scheme • supplement public scheme e.g. for hospital upgrades PMI tends to be regressive, i.e. accessible mainly to higher income people