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3 results

  • 7 - Healthcare Reforms over the Last Thirty Years

  • Federico Toth, Università degli Studi, Bologna, Italy
  • Book:
    Comparative Health Systems
    Published online:
    20 August 2021
    Print publication:
    09 September 2021, pp 179-207

  • Summary

    The purpose of this chapter is to reflect on the main trajectories of change that have characterized the health systems of OECD countries in the last three decades, from the fall of the Berlin Wall to the present day. For this purpose, it is possible to identify five major "reform themes" which traveled transversally through countries generating processes of emulation and policy transfer. The five major reform themes are as follows: (1) stimulation of greater competition; (2) promotion of integration (both in terms of financing and provision); (3) decentralization; (4) strengthening the rights of the patient; (5) extension of insurance coverage. For most of these five themes it is possible to identify a reform that has acted as a forerunner, which other countries have subsequently been inspired by and followed.

Comparative Health Systems
  • A New Framework
  • Federico Toth
  • Published online:
    20 August 2021
    Print publication:
    09 September 2021
  • The standard classifications of health systems don't allow for the complexity and variety that exists around the world. Federico Toth sets out a new framework for understanding the many ways in which health systems can be organized and systematically analyses the health systems chosen by 27 OECD countries. He provides a great deal of up-to-date data on financing models, healthcare spending, insurance coverage, methods of organizing providers, healthcare personnel, remuneration methods for doctors and hospitals, development trajectories and recent reforms. For each of the major components of the healthcare system, the organizational models and the possible variants from which individual countries can ideally select are defined. Then, based on the organizational solutions actually adopted, the various national systems are grouped into homogeneous families. With its clear, jargon-free language and concrete examples, this is the most accessible comparative study of international healthcare arrangements available.

  • DO CHANGES IN SURGICAL PROCEDURES FOR BREAST CANCER HAVE CONSEQUENCES FOR HOSPITAL MEAN LENGTH OF STAY?: A Study of Women Operated on for Breast Cancer in Sweden, 1980–95

  • Rikard Lindqvist, Torgil R. Möller, Magnus Stenbeck, Finn Diderichsen
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 18 / Issue 3 / 22 2002
    Published online by Cambridge University Press:
    19 December 2002, pp. 566-575

  • Background: Between 1986 and 1996, the overall mean overnight length of stay for all diagnoses in Sweden decreased from 20.8 to 7.1 days.

    Objectives: The study describes changes in surgical technique, from mastectomy to breast-conserving surgery, in treatment of female breast cancer and the parallel change in average length of hospital stay, and discusses the possible link between the trends.

    Research Design: The study was performed as a descriptive register study on hospital admission data from the Swedish Hospital Discharge Register over a 16-year period (1980–95).

    Results: During the study period, the mean length of stay for surgical curative breast cancer treatment in Sweden decreased by 56%. In 1980, the proportion of women receiving conservative surgery was 7%. At the end of the period, this share had increased to 51%. Breast-conserving surgery had an approximately 30% shorter mean length of stay compared with mastectomy. The gap was remarkably stable during the study period. The shift from mastectomy to breast-conserving surgery had a limited effect on the share of patients that went through lymph node dissection. Neither age nor the number of operations per woman could, to any significant extent, explain the decrease in mean length of stay. Approximately 14% of the overall decline can be attributed to the changes in technique.

    Conclusions: Clinical practice style, in this case the surgical technique, has had an effect on length of stay, but the surgical technique can only to some extent explain the trend.