The "four categories of healthcare" model facilitates discussion of healthcare system reform which moves beyond broader framings such as taxation-funded ("Beveridge") or insurance-based ("Bismarck") systems, and enables consideration of national and transnational (EU) influences.

This model has facilitated discussion of healthcare by competition lawyers, and of competition/marketisation by health lawyers and health policy analysts. It has also been useful in introducing the UK healthcare system and the interaction between the National Health Service (NHS) and private healthcare to international audiences.

The model was initially developed to explain competition reforms of the English NHS (Guy 2019), but has since been used to broaden discussion of EU state aid cases in healthcare. 

How does it work?

Category 1 - Public Purchaser and Public Provider:

This refers to a patient accessing treatment within the public healthcare system. 

Category 2 - Public Purchaser and Private Provider:

This refers to a patient accessing treatment from a private provider within the public healthcare system. The patient's status does not change, and costs are not chargeable directly to the patient.

Category 3 - Private Purchaser and Public Provider:

This refers to a patient paying for treatment within the public healthcare system, for example, because they want to access treatment more quickly, or because nationality status may require additional payment for access. 

Category 4 - Private Purchaser and Private Provider:

This refers to a patient paying for treatment from a private healthcare provider, so does not involve the public healthcare system. 

These 4 categories allow analysis and examination of topics as diverse as patient choice policies, outsourcing of public healthcare services, patient movement between public and private healthcare systems (and changing patient status and entitlement). The model can therefore relate to healthcare systems as diverse as the UK, Italy, and Estonia.

Learn more