Classifying healthcare systems at introduction: Types of healthcare systems under public responsibility

This paper provides a descriptive account of types of healthcare systems under public responsibility as they were introduced worldwide. Based on the actor-centred typology proposed by Frisina Doetter et al. (2021) and a definition for emergent healthcare systems (de Carvalho & Fischer, 2020), we have examined 167 independent countries with a population of more than 500,000 and classified healthcare systems as they were shaped at inception. The classification results in 14 types of healthcare system with distinct actor combinations in regulation, financing, and service provision. If only the regulation and financing dimension are considered, healthcare systems can be condensed into six deductively created clusters. The focus on the regulation dimension reveals two worlds of healthcare – a state-regulated and a societally regulated world. While systems that rely on societal actors mainly emerged prior to the mid-20th century, state-based systems have characterized system introductions since then.