Purpose: The aim of the article is to build a theoretical framework for analysis of
dynamic relationships between expenditures and accessibility in various health care
systems.

Methodology: The institutional model of patient-payer relations in different contractual
settings was presented. The proposed model allows quantification of economically
relevant parameters for this kind of contract, which makes comparative
analysis of health care systems with regard to expenditures and access to health care
more tractable and explicit.

Findings/originality: Four main characteristics of patient-payer contracts were
identified: elasticity of demand with regard to “accessibility” and “expenditures”
variables, and restrictions imposed on variability for access and expenditures.
It is shown how these characteristics determine the dynamics of trade-offs between
accessibility and expenditures in health care systems, especially in the context of
cost pressures resulting from technological progress in medicine.