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The Healthcare Public System – Does Standardization Withhold the Bucket from Leaking?


The public healthcare system is heavily influenced by the 3C trilemma - cost - coverage - choice. The paper’s argument tackles the fact that should the public decision on improving capacity be leaning towards universal coverage in would result in efficiency losses and, in an attempt to control the costs it would limit patients’ choice. Should priority be given to performance or value? The present paper deals with the compromise between the equity and efficiency, a leaky bucket that becomes more visible in the struggle to build capacity and intervene in the market by setting standards. Setting healthcare standards is a global concern, the 3rd Sustainable Development Goal is a clear proof of that the aim to emphasise and better analyse two of the most influential variables: efficiency and equity. All in all, what we argue is that the current leaky bucket is a trade-off between choice, coverage, and cost. For a complex public service like healthcare, targeting a full coverage and multiple choice would incur huge costs and, cutting costs considerably restricts both the choice and coverage. The cost is influenced by the production capacity use when the activity has large fixed costs.