Abstract
Despite the intense debates over state or private sector dominance in healthcare finance and provision, there are no clear winners. Failed models exist on either end of the ideological spectrum and no country in the world has one that is purely public or purely private. Neither does a perfect public–private mix exist; all solutions are, at best, partial. The important questions are whether or not the political choices made are affordable, sustainable and equitable. When ideology meets reality, it boils down to what trade-offs different societies at different stages of economic development are willing to make.