The healthcare sector is one of the fastest growing areas of social and public spending worldwide, and it is expected to increase its government shares of GDP in the near future. Truly global in its scope, this book presents a unified, structured understanding of how the design of a country's health institutions influence its healthcare activities and outcomes. Building on the 'public choice' tradition in political economy, the authors explore how patient-citizens interact with their country's political institutions to determine the organisation of the health system. The book discusses a number of institutional influences of a health system, such as federalism, the nature of collective action, electoral competition, constitutional designs, political ideologies, the welfare effects of corruption and lobbying and, more generally, the dynamics of change. Whilst drawing on the theoretical concepts of political economy, this book describes an institution-grounded analysis of health systems in an accessible way. We hope it will appeal to both undergraduate and graduate students studying health economics, health policy and public policy. More generally, it can help health policy community to structure ideas about policy and institutional reform.

‘An important effort to understanding health policies through a shrewd lens of relevant political and economic institutions. A textbook undoubtedly needed to define new policies at a time our patients are losing patience.'

Guillem Lopez Casasnovas - Universitat Pompeu Fabra

‘Citizens in democratic countries choose to spend more on health care and to channel more of that spending through the public sector as their incomes rise, but among these countries there is substantial variation in private payments out of pocket and variety of choices among health plans. In contrast to most analyses that see these variations as reducing overall welfare, this book takes the refreshing view that they are determined by voter preferences in a setting that acknowledges both constitutional rules and government as well as market imperfections. It provides valuable insights on whether things can be arranged better in some countries, given unavoidable constraints on government actions and political actors – insights that both help us understand what happens and what is possible.'

Mark Pauly - Wharton School, University of Pennsylvania