Rethinking the private-public mix in health care: analysis of health reforms in Israel during the last three decades.

OBJECTIVES: To analyse the process of health care privatization using the case of Israeli health care reforms during the last three decades.

METHODS: We used mixed methods including quantitative analysis of trends in health expenditures in Israel and qualitative critical analysis of documents describing the main health reforms.

RESULTS: Israel epitomizes how boundaries between the private and public sector become blurred when health care services are subject to privatization, both of finance and supply. Additionally, the continuous growth of public-private relationships in health care results in systems that lack both equity and efficiency.

CONCLUSIONS: More than three decades of experience show that such private-public partnerships increase both inequality and inefficiency. While most discussion surrounding the private-public mix in health care focuses on financing infrastructure, in Israel, the public-private mix has become a central way of financing and delivering services, making its damaging influence more pervasive.