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

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 c...

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Bibliographic Details
Published in:Health economics, policy and law policy and law, 2010-07, Vol.5 (3), p.269-293
Main Authors: Or, Zeynep, Cases, Chantal, Lisac, Melanie, Vrangbæk, Karsten, Winblad, Ulrika, Bevan, Gwyn
Format: Article
Language:English
Subjects:
Cancer
Choice Behavior
Cost shifting
Delivery of Health Care - economics
Delivery of Health Care - organization & administration
Europe
Expenditures
Health care
Health care expenditures
Health care policy
Health Care Reform
Health economics
Health problems
Health Services Accessibility
Health Services Needs and Demand
Heterogeneity
Humans
Life expectancy
MEDICIN
MEDICINE
Models, Economic
Models, Organizational
Mortality
Organizational structure
Patient Satisfaction
Pharmaceuticals
Politics
Prostate
Public health
Reforms
Studies
Waiting Lists
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Summary: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.
ISSN:1744-1331
1744-134X
1744-134X
DOI:10.1017/S1744133110000034