Improving Institutions: Ingredients, Not Recipes
practices, with the former being more common. Seven of the 17 relying on private providers cover their populations through national health services as described above: Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the United Kingdom. These correspond to what has been called the public contracting model, with public finance and private provision, a hybrid between the public integrated model and private insurance and provision model (Docteur and Oxley 2003). Public provision of primary care is found in seven OECD countries, mostly in the Mediterranean or Scandinavian regions: Finland, Iceland, Italy, Mexico, Portugal, Spain, and Sweden. (Here and below we rely on national data for Spain and Sweden, while noting that there are differences across regions within these countries with respect to some health system characteristics.) But Finland, Mexico, and Sweden have a secondary reliance on private practice. Thus, full reliance on public primary care is increasingly rare. A similar public-private mix for primary care is found in the western part of the ECA region, with public centers more common in the former Yugoslavia (except Croatia and the former Yugoslav Republic of Macedonia) and private primary care the norm in new EU member states. In the eastern part of ECA, publicly provided primary care is the model prevailing in all 12 countries with the exception of Georgia. With regard to outpatient specialist care, there is a wider range of approaches within regions, in part due to differences in whether such care takes place in a separate clinic or in a hospital setting. Private clinics are the primary mode of provision in 14 OECD countries, while 8 rely on public hospitals and 2 on public centers. In western ECA, 5 countries use private centers, 8 use hospitals, and 4 rely on public centers. In eastern ECA, publicly provided outpatient specialist care is again the norm in all countries (either in polyclinics or in hospitals), with the exception of Georgia. In the case of hospital ownership, there is far less diversity within and across regions. In brief, public hospitals are the predominant mode of delivery in all regions (figure 6.3). A minor caveat to this pattern is that OECD countries have a somewhat larger role for private nonprofit hospitals, which are relatively scarce in ECA countries. Out of over 50 countries surveyed, the only country in which for-profit hospitals account for a majority of acute-care beds is Georgia. But beyond the public-private mix, other important aspects of hospital management do differ across countries, as discussed below. Thus, regarding the public-private mix in service delivery, the major difference between ECA (and more specifically the eastern
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