A second opinion: rethinking the public-private dichotomy for health insurance

Does the public-private dichotomy effectively describe health insurance systems in the advanced industrialized democracies? Is the boundary separating the public and private sectors accurate for studies o f social policy formation and cutback? This article has three goals. The first is to discuss reasons for reconsidering the public-private dichotomy, as it applies to health insurance systems. The second is to offer a reconceptualization of the public-private demarcation useful for analyses of health insurance systems; the author presents four sectors that may illuminate patterns of health insurance for different OECD countries: the social, individual, public, and market sectors. The third goal is to present results using a new methodological approach useful for studying complex social phenomena: the fuzzy-set approach, which allows researchers to treat social phenomena as partially belonging to more than one category. This approach is employed to demonstrate that health insurance provision rarely is solely public or private, but is formed by a combination of sectors. Underlying these three goals is the contention that comparative and historical sociological researchers can offer innovative approaches to the study of health insurance and the interests served by public and nonpublic health insurance programs through reconceiving the public-private dichotomy.