Public healthcare is sadly no silver bullet. In ideal private insurance scenario you pay some amount and get increasing credit for healthcare expenses, so the user is incentivised to chose best cost performing treatment (cheapest option providing adequate treatment) and providers are incentivised to obey free market rules and keep fees under control (sans cartels/antitrust, market segmentation). In publicly funded scenario without coupling between payments and usage, user is incentivised to seek the most "premium" treatment and providers are not incentivised to reduce operational costs.
If the public system covers anything more than emergency care (patch a patient up and let them go) it automatically creeps into all service levels (have a basic cough? maybe that's bacterial pneumonia, better issue referrals for microbiological analysis and a CT scan. /s) if an answer to the question "if family doctor/general practitioner cannot appoint diagnosis and/or treatment and refers patient to a specialist and/or analyses, scans, etc. are those covered too?" is yes.
The payer (government, taxpayers) probably has 3 mechanisms to keep [total] costs from skyrocketing all with their disadvantages:
1. Reduce usage count (doctor visits) - free visit quotas (possibly dependant on service level), fixed or percentage mandatory user fee, etc;
2. Fix service costs - e.g. 100$ for a GP visit from public pool;
3. Auction paid service quotas.
While option 3 provides most incentives to optimise costs, it greatly punishes small players.
> If the public system covers anything more than emergency care (patch a patient up and let them go) it automatically creeps into all service levels (have a basic cough? maybe that's bacterial pneumonia, better issue referrals for microbiological analysis and a CT scan. /s)
No. In the UK, if you go into a GP's office with a cough, you'll be told to go home and rest. In fact, most likely, you'll be denied from making an in-person appointment. This is FUD in its plainest form.
The only place I've ever seen private healthcare provision work about as well as public (Singapore), it was with price controls and a public at-cost option that competed with private options.
The idea that price controls don't work in America is, of course, an article of faith in the free market religion. It wouldn't fly there.
Spiraling costs is a much bigger risk in private "free market" systems, which is largely how America gets to spend 2x more of its GDP on roughly equivalent healthcare outcomes (mortality rates, etc.) to European single payer systems.
> user is incentivised to seek the most "premium" treatment
They can "seek" it, but in the public system you don't really have a route for doing that. You might want a CT scan, but if your doctor doesn't think you need it you're not going to get it.
Your list left off (4) queueing. In the UK public system, if your condition is not urgent you'll have to wait, possibly for months. Unless you have private top-up insurance which will cover the specialist you're waiting for.
(It's difficult to estimate how much money the NHS saves by people on queues for non-urgent operations dying from something unrelated in the meantime - e.g. dying of a heart attack while waiting a year for a hip replacement)
Queues are a result of mentioned instruments. Say a hospital has a CT scanner capable of 10 scans per day, 3,5k scans per year. NHS pays for 500. A hospital can fully utilise the scanner and blow their yearly budget of publicly funded scans in two monts, do 10 free scans a week or do 8 scans and save 2 for emergencies. Placing more scanners does not reduce queues.
The CT scanner is usually owned by the NHS trust, which makes the marginal cost of using it rather small. It's almost the other way round: having bought a big capital asset, the incentive is to make sure it's kept busy being used effectively. The NHS "internal market" obfuscates this hugely, but there is still no incentive to over-provision because the system can't drive up external insurance costs.
If the public system covers anything more than emergency care (patch a patient up and let them go) it automatically creeps into all service levels (have a basic cough? maybe that's bacterial pneumonia, better issue referrals for microbiological analysis and a CT scan. /s) if an answer to the question "if family doctor/general practitioner cannot appoint diagnosis and/or treatment and refers patient to a specialist and/or analyses, scans, etc. are those covered too?" is yes.
The payer (government, taxpayers) probably has 3 mechanisms to keep [total] costs from skyrocketing all with their disadvantages:
While option 3 provides most incentives to optimise costs, it greatly punishes small players.