Encouraging private initiative

This book recommends a pluralistic delivery system, in line with the principle of competition (principle 3) and with international experience. This chapter deals primarily with ownership reform, but in relation to this, it also covers other problems concerning the economic issues of organization and contracting between producers (i.e. providers) and insurers.

Let us begin with what is not being recommended here. It is not that a great “blueprint” should be prepared, showing in advance which organizations should stay in public ownership and which should pass into private hands. The authors would advise firmly rejecting any privatization campaign that laid down beforehand when some critical threshold value for privatization had to be reached. Any decision that tried to organize the private health-care sector completely from above could only cause confusion.

On the other hand, much greater encouragement should be given to private initiative from below, in all its legally, ethically, and professionally correct forms. The book argues in several places for principle 1 to apply in the patients' interest. The principle also applies to providers, who have rights of individual sovereignty and initiative in their capacity as doctors, other health professionals, and entrepreneurs in the sector. Beyond basic prudential state regulation, there is no need for reformers to decide in advance what forms of private initiative are most desirable. Let them permit, and, indeed encourage, experimentation. It will emerge in due course what forms are most viable.