SUMMARY

This article embraces the interrelations between the public and private health insurance within public healthcare systems. The theoretical and empirical context to which these interrelations must refer in order to reach analysis consistency, beyond the specific details about the functioning of both sectors, is given. The fact that the state corrective intervention of the “market failure” in health is considered as optimum in terms of social well-being, does not derive from the substitution of the private insurance field by the public one, but from their complementarity. It is the “menu of contracts” what makes the public intervention efficient.

In general, in the literature embracing the economy of health, the interrelations between these two forms of assurance are reviewed in a very political, dicotomical way, easily disqualifying, by using rather doubtful equity arguments, and from a conjuncture biased perspective; among them, the presence of waiting lists due to financial lacks of the public system, the complaints on the part of the professionals before the rewarding deficiencies of their activity within the private insurance field, the bad preventative regulation of some patient transfers and/or of the compatibility during the professional exercise of the doctors that would interrelate both sectors of healthcare. We see then, a huge gap between the theoretical purposes and the reality on a daily basis with which the two assurance fields operate.

All the same, the trends in the Western world healthcare systems evolution that have been observed, point at a certain covering universalization, at least when it comes to some of their most basic compounds, and also within the social insurance systems that get articulated from private insurance offers. That makes the private insurance partially reposture from any kind of universal covering to the possibility of managing the public insurance policies instead of the state provision, keeping the last one covering the basic compound, to be voluntarily complemented with additional covering loans. This gets fostered too, by the every time more usual trend of better showing the loans covered by the public insurance, in some cases, openly upon the base of the cost-effectiveness of the treatments. Given the fact that what is not included in the standard public covering is not unallowed, but simply unearned, the role of the private sector gets clear. Since the medical innovation boost steps from the idea of the quality of life individually considered, rather than from a socially objectivable therapeutic and diagnostic effectiveness, there is no doubt that the future of the private sector counts on many open windows of opportunity.

This fact itself helps to concrete the role of the private health insurance within the patterns of the public provision, both at its (i) substitutive level (for people excluded from the mandatory covering, who have right to an “opting out”, given their income level makes non-necessary to depend on the public guardianship, like in Germany until January 2007, and also in Holland); (ii) complementary, with respect to excluded services (for instance, the dental ones and some forms of alternative treatments) or only partially covered (that imply the co-paying on the part of the users); and (iii) supplementary, in order to increase the choice opportunity of the provider and/or the fast access to the healthcare services. The text proposes that these alternatives bring the possibility to open new ways of complementary financing that “would decompress” the public treasury and allow a better adapting between supply and demand of health services on the part of the citizens towards the public-private compound of the healthcare system. To this point, the goal aims at keeping a broad range private concerted healthcare sector regarding both the buying of public and private services to keep the diversity, the management autonomy, and the innovative experimentation, and to avoid the bureaucratization of every sanitary structure and the consideration of the public insurance and public substitutive provision management, to be privately complemented, on the part of the health insurance that wishes so.

In this sense, the text pleads for recognising some fallacies we are in (apart from the political speech in favour of realism and the redirection of the core of attention of the analysis in the sense, as far as we know, pointed out in the text.