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Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems

Published online by Cambridge University Press:  01 July 2010

Zeynep Or ,
Chantal Cases ,
Melanie Lisac ,
Karsten Vrangbæk ,
Ulrika Winblad  and
Gwyn Bevan
Zeynep Or*
Affiliation:
Institute for Research and Information in Health Economics, Paris, France
Chantal Cases
Affiliation:
Institute for Research and Information in Health Economics, Paris, France
Melanie Lisac
Affiliation:
Bertelsmann Foundation, Guetersloh, Germany
Karsten Vrangbæk
Affiliation:
Department of Political Science, University of Copenhagen, Denmark
Ulrika Winblad
Affiliation:
Department of Public Health and Caring Sciences, Uppsala University, Sweden
Gwyn Bevan
Affiliation:
Department of Management, London School of Economics and Political London School of Economics and Political Science, UK
*
Correspondence to: Zeynep Or, Institute for Research and Information in Health Economics, 10 rue Vauvenargues, 75018, Paris, France. Email: [email protected]
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Abstract

Industrialised countries face similar challenges for improving the performance of their health system. Nevertheless, the nature and intensity of the reforms required are largely determined by each country’s basic social security model. Most reforms in Beveridge-type systems have sought to increase choice and reduce waiting times while those in major Bismarck-type systems have focused on cost control by constraining the choice of providers. This paper looks at the main differences in performance of five countries and reviews their recent reform experience, focusing on three questions: Are there systematic differences in performance of Beveridge and Bismarck-type systems? What are the key parameters of healthcare system, which underlie these differences? Have recent reforms been effective?

Our results do not suggest that one system-type performs consistently better than the other. In part, this may be explained by the heterogeneity in organisational design and governance both within and across these systems. Insufficient attention to those structural differences may explain the limited success of a number of recent reforms. Thus, while countries may share similar problems in terms of improving healthcare performance, adopting a ‘copy-and-paste’ approach to healthcare reform is likely to be ineffective.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 3: Special Issue on Cross-Country Issues in Health Care: Choice, Equity, Efficiency and Cost , July 2010 , pp. 269 - 293
Copyright
Copyright © Cambridge University Press 2010

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References

Appleby, J., Harrison, A.Devlin, N. (2003), What is the Real Cost of More Patient Choice?, London, UK: King’s Fund. http://www.kingsfund.org.uk/publications/kings_fund_publications/what_is_the_real.htmlGoogle Scholar
Audit Commission and Healthcare Commission (2008), Is the Treatment Working?, London: Audit Commission. http://www.audit-commission.gov.uk/reports/NATIONAL-REPORT.aspGoogle Scholar
Bevan, G. (2008), ‘Is choice working for patients in the English NHS?’, British Medical Journal, 337: a935.CrossRefGoogle ScholarPubMed
Bevan, G. (2009), ‘Have targets done more harm than good in the English NHS?’, British Medical Journal, 338: a3129.CrossRefGoogle ScholarPubMed
Bevan, G.Hood, C. (2006), ‘What’s measured is what matters: targets and gaming in the English public health care system’, Public Administration, 84(3): 517–538.CrossRefGoogle Scholar
Bevan, G.Robinson, R. (2005), ‘The interplay between economic and political logics: path dependency in health care in England’, Journal of Health Politics Policy and Law, 30: 53–78.CrossRefGoogle ScholarPubMed
Comptroller and Auditor General (2007), Pay Modernisation: A New Contract for NHS Consultants in England [HC 335 2006–2007] . London: The Stationery Office 〈http://www.nao.org.uk/publications/nao_reports/06-07/0607335.pdf〉Google Scholar
Comptroller and Auditor General (2008), NHS Pay Modernisation: New Contracts for General Practice Services in England. [HC 307 Session 2007-2008]. London: The Stationery Office. 〈http://www.nao.org.uk/publications/nao_reports/07-08/0708307.pdf〉Google Scholar
Coulter, A.Magee, H. (2003), The European Patient of the Future, Maidenhead: Open University Press.Google Scholar
Dixon, A., Robertson, R., Bal, R. (2010), ‘The experience of implementing choice at point of referral: a comparison of the Netherlands and England’, Health Economics, Policy and Law, 5: 295–317.CrossRefGoogle ScholarPubMed
ESPS (2004), Enquête Santé et Protection sociale, Paris: IRDES. http://www.irdes.fr/EspaceRecherche/Enquetes/ESPS/EnqueteESPS.htmlGoogle Scholar
Eurobarometer (2007), Public Opinion in the European Union, November 2007. Report available on line: http://ec.europa.eu/public_opinion/archives/eb/eb67/eb67_en.pdfGoogle Scholar
Fredriksson, M.Winblad, U. (2008), ‘Consequences of a decentralised healthcare governance model: measuring regional authority support for patient choice in Sweden’, Social Science and Medicine, 67: 271–279.Google ScholarPubMed
Flood, C.M., Haugan, A. (2010), ‘Lessons for Canada from regulatory approaches to the public/private divide in Sweden, the UK, the Netherlands, Germany and France’, Health Economics, Policy and Law, 5: 319–341.CrossRefGoogle Scholar
Hanning, M.Lundström, M. (1998), ‘Assessment of the waiting time guarantee for cataract surgery’, Int Journal of Technology Assessment in Health Care, 14(1): 180–193.CrossRefGoogle ScholarPubMed
Hanning, M.Winblad Spångberg, U. (2000), ‘Maximum waiting time – a treat to clinical freedom? Implementation of a policy to reduce waiting times’, Health Policy, 52: 15–32.CrossRefGoogle Scholar
NHS Scotland (2003), Partnerships for Care. Scotland’s Health White Paper, Edinburgh: The Stationery Office 〈http://www.scotland.gov.uk/Resource/Doc/47032/0013897.pdf〉Google Scholar
National Audit Office (2008), NHS Pay Modernisation: New Contracts for General Practice Services in England, London: The Stationery Office.Google Scholar
OECD (2006), Health Care Quality Indicators Project, Conceptual Framework Paper, by Kelly E. and Hurst J., OECD Health Working Papers, No. 23, Paris.Google Scholar
OECD Health Data (2008), available on CD-ROM, OECD, Paris. Online version at: www.oecd.org/health/healthdataGoogle Scholar
Or, Z. (2002), From Measures to Action: Improving the Performance of Health Care Systems, A Review of Four Countries, OECD Labour Market and Social Policy Occasional Papers, No. 57, 2002.Google Scholar
Propper, C., Sutton, M., Whitnall, C.Windmeijer, F. (2008), ‘Did ‘targets and terror’ reduce waiting times in England for hospital care?’, The B.E. Journal of Economic Analysis & Policy, 8(2, Article 5. http://www.bepress.com/bejeap/vol8/iss2/art5)CrossRefGoogle Scholar
Redaktionsbüro Gesundheit (ed.) (2007), Regionale Hausarztmodelle in Deutschland – Recherche des Redaktionsbüros Gesundheit bei den gesetzlichen Krankenkassen und Kassenärztlichen, Stand: Vereinigungen: Dezember 2007. www.uke.uni-hamburg.de/institute/allgemeinmedizin/downloads/institut-allgemeinmedizin/BMG-Uebersicht-HA-Modelle-Dland.pdfGoogle Scholar
Robertson, R., Torlby, R. (2007), Patient choice, King’s Fund Briefing, January 2008. http://www.kingsfund.org.uk/publications/briefings/patient_choice_1.htmlGoogle Scholar
Scilliani, L., Hurst, J. (2003), Explaining Waiting Times Variations for Elective Surgery across OECD Countries, OECD Health Working Papers, No. 7, Paris.Google Scholar
Secretary of State for Health (2000), The NHS Plan [CM 4818-I]. London: The Stationery Office. http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4002960&chk=07GL5RGoogle Scholar
Secretary of State for Health (2002), Delivering the NHS Plan [CM 5503], London: The Stationery Office. http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4005818&chk=zN/MoeGoogle Scholar
Smith, P. C. (2002), ‘Measuring health system performance’, European Journal of Health Economics, 3: 145–148.CrossRefGoogle ScholarPubMed
Socialstyrelsen (2010), Uppföljning av den nationella vårdgarantin och “kömiljarden” [Evaluation of the National Waiting-time guarantee]. Årsrapport 2010. Artikelnummer: 2010-3-12.Google Scholar
Strandberg-Larsen, M., Nielsen, M. B., Vallgårda, S., Krasnik, A., Vrangbæk, K.Mossialos, E. (2007), ‘Denmark: health system review’, Health Systems in Transition, 9(6): 1–164.Google Scholar
Trigg, N. (2008) Private health market ‘shrinks’. 〈http://news.bbc.co.uk/1/hi/health/7699563.stm〉Google Scholar
The Information Centre (2008a), General and Personal Medical Services: England 1997–2007, http://www.ic.nhs.uk/webfiles/publications/nhsstaff2007/gp/GP%20Bulletin%201997-2007.pdfGoogle Scholar
The Information Centre (2008b), NHS Hospital and Community Health Services: Medical and Dental staff. England 1997–2007. http://www.ic.nhs.uk/webfiles/publications/nhsstaff2007/med%20and%20den/Revised%20Medical%20and%20Dental%20bull%2097-07.pdfGoogle Scholar
The Labour Party (1997), ‘Labour Party Manifesto’, New Labour because Britain deserves better, London: Labour Party. http://www.labour-party.org.uk/manifestos/1997/1997-labour-manifesto.shtmlGoogle Scholar
Tuohy, C. (2008), What role for social insurance in tax-financed healthcare systems: a Canadian perspective. Presentation to the King’s Fund, London, April 28, 2008.Google Scholar
Vrangbæk, K., Østergren, K., Okkels, B.Winblad, U. (2007), ‘Patient reactions to hospital choice in Norway, Denmark and Sweden’, Health Economics, Policy and Law, 2: 125–152.CrossRefGoogle ScholarPubMed
Wasem, J. (1999), Das Gesundheitswesen in Deutschland: Einstellungen und Erwartungen der Bevölkerung. Wissenschaftliche Analyse und Bewertung einer repräsentativen Bevölkerungsstudie, Neuss: Eigenverlag Janssen-Cilag.Google Scholar
Welsh Assembly Government (2008), Proposals to Change the Structure of the NHS in Wales. Consultation Paper, Cardiff: Welsh Assembly Government. http://www.wlga.gov.uk/english/library/nhs-structure-consulation-document/>>Google Scholar