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Toward a new conceptualization of health care services to inspire public health. Public national health service as a “common pool of resources”

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Abstract

The recent financial crisis weakened Western economies, disclosing their frailties and exerting a strong pressure on the sustainability of their welfare systems. Among others, publicly-funded national health systems, a cornerstone of the “welfare state model” in most of European countries, face a hard period, tightened in the stranglehold between scarce resources and increasing health needs. This paper conceives health services provided by publicly-funded national health systems as “non-excludable”, but “rival” goods. Drawing on this interpretation, publicly-funded national health systems are understood as “common pools of resources”. A theoretical standpoint is adopted to discuss this topic. The article proposes general reasoning and basic remarks, deferring to further developments empirical applications. The paper contributes to the scientific literature by offering a new perspective from which the functioning of publicly-funded national health systems could be investigated. The “Common Pool Resources” theory and the “Institutional Analysis and Development” framework are proposed as key tools to inspire public health policies. They allow to examine in-depth the sustainability issues of publicly-funded national health systems, paving the way for innovative approaches in health care management and marketing.

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Notes

  1. This quote is drawn from the web page of the World Health Organization about national health systems. It was retrieved from: http://www.who.int/topics/health_systems/en; this web page was last accessed on November, 15th 2016.

  2. Several Authors (Zweifel et al. 2009; Diaby et al. 2013) claim that health is a priceless good. Therefore, the absence of a perceived cost to access health services fosters the growth of the demand of care, paving the way for imbalances in the functioning of health systems.

  3. Crivellini (2004) emphasizes the chasm between the concepts of “health” and “health care”, criticizing the bias of public expenditure to favour the latter rather than the former.

  4. Hardin’s thesis excited a vivid academic debate. Several scholars disagree with the assumption of an unavoidable “tragedy” of collective goods (Feeny et al. 1996; Ostrom 1998), claiming that organized groups of appropriators are able to effectively manage collective goods.

  5. “Stocks” can be defined as a resources’ container, while “flows” are the dynamics which affect the dimension of stocks, either in a positive (inflow) or a negative way (outflow).

  6. The crowding-out of appropriate services causes several negative effects, including: the lengthening of waiting lists, the waste of resources in the provision of inappropriate care and the worsening of the community health status.

  7. QALY (Quality Adjusted Life Years) is an evaluation method to assess the outcomes associated with the provision of health services. In particular, it measures the number of earned life years adjusted for the quality of life which could be ascribed to a health treatment (Gudex and Paul 1988).

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  1. Department of Management & Innovation Systems, University of Salerno, 84084, Via Giovanni Paolo II, nr 132, Fisciano (Sa), Italy

    Rocco Palumbo

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Palumbo, R. Toward a new conceptualization of health care services to inspire public health. Public national health service as a “common pool of resources”. Int Rev Public Nonprofit Mark 14, 271–287 (2017). https://doi.org/10.1007/s12208-017-0175-1

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