Introduction

Over the last two or three decades, close scrutiny has been given to the issue of health care financing (HCF) in countries at different levels of economic development. The desire for alternative or complementary ways to generate financial resources for health care has in part been driven by need, namely resource shortages and rapidly rising costs. At the same time, however, policy choices have been influenced by particular ideas and values concerning the role of the state, and its perceived responsibilities to finance and provide health care.

Traditional approaches to the study of public policy have focused on the national level and, in particular, the role of the state and government actors as the holders of formal authority to take decisions on behalf of the public interest (Anderson 1975; Rose 1975; Frederickson and Wise 1977). This has been particularly evident in health policy analysis. While certain non-state actors (e.g. private companies, professional associations) have long been recognised as important to public policy-making, they have largely been described as interest groups seeking to influence (e.g. lobbying) a formal process that is essentially focused on the state and its government. Given that the state is taken as the primary unit of analysis, international health is largely equated with comparative analyses of national health policy-making (Leichter 1979)

Since the mid 1980s, analysis of health policy has changed in two main ways. First, there has been recognition of the greater significance, both quantitatively and qualitatively, of non-state actors.