Insurance has been a dominant concept in health care in the industrialized world since the late 19th century, originating in the Bismarckian welfare state. Today, insurance is a method for organizing and financing health care; more importantly it is a metaphor that heavily influences how we conceive of health and health care and the behaviours of those who govern, manage, and deliver care. This presentation argues that many of the cost, distributional, and performance problems common to all contemporary health care systems are attributable to an over-reliance on insurance concepts and principles . It contrasts an insurance conceptual foundation with as public good, public service formulation and suggest that moving away from the insurance metaphor will enhance the prospects for more needs-based resource allocation, reduced health disparities, and improved system performance.
