Reform and regulation of health care systems in Europe

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Health care expenditure currently represents an average of 9% of GDP in OECD countries, and it continues to increase, notably as a result of progress in medical techniques, the ageing of the population and also people’s growing demands vis-à-vis the health care system. Yet all Western countries have undertaken reform of their health care systems.

What are the objectives and issues of the reforms adopted by European countries since the 1990s ? Analysis of the reforms presented in this issue reveals a common objective : to regulate health care systems in order to contain expenditure whilst ensuring the highest quality of health care and, if possible, its equitable distribution, and encouraging innovation. Measures implemented by European countries aimed at meeting these objectives are diverse. They vary according to the history and age of the system, its nature (whether inspired by the Bismarck or the Beveridge system), and the role attributed to the private sector and to public, central and local authorities.

Two orientations have nonetheless clearly emerged since the beginning of the 1990s :

- the decentralisation of the decision-making and management of the health care system, a process that can take many forms and produce varying results, notably because of power struggles ;

- the introduction of competitive mechanisms (between health care insurance providers and health care providers), a form of competition that is often regulated by public authorities in order to protect policyholders.

Pinpointing the differences between European systems, in terms of both means and results, enables us to speculate on new ways to improve access to quality health care, at a cost that is affordable for both the individual and society, and to ensure the sustainability of the health care system.

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- Presentation of the issue

Françoise Leclerc

La régulation des systèmes de santé : concilier qualité et coût ?

- Evolution of health expenditure in OECD countries

Francesca Colombo et David Morgan

- The question of regulating health systems Aspects of economic analysis

Michel Grignon

- Identification of health baskets in nine EU countries

Marcial Velasco-Garrido, Jonas Schreyögg, Tom Stargardt et Reinhard Busse

- GPs and access to out-of-hours services in six European countries (Germany, Spain, France, Italy, the United Kingdom and Sweden)

Laurence Hartmann, Philippe Ulmann et Lise Rochaix

- Access to regular health care in Europe Outline presentation

Laurence Hartmann, Philippe Ulmann et Lise Rochaix

- A look at private health care insurance in the European Union

Henri Lewalle

La mise en œuvre des réformes dans quelques pays européens

Les systèmes d’assurance

- Implementation of health care reforms in the Bismarckian systems : unequal capacities

Antoinette Catrice-Lorey et Monika Steffen

- Fair funding and competitive governance The German model of health care organisation under debate

Ingo Bode

- The Netherlands : reform of the health system based on competition and privatisation

Sylvie Cohu, Diane Lequet-Slama et Pierre Volovitch

- The role of health insurance in regulating the Swiss health care system

Iva Bolgiani, Luca Crivelli et Gianfranco Domenighetti

Les systèmes nationaux de santé

- Regulation and relations between the different participants in the English health care system

Anne Mason et Peter C. Smith

- Changes in the responsibilities and financing of the health system in Italy

Valeria Fargion

- Sixty years of reform in the Portuguese health system : what is the situation with regard to decentralisation ? Viewpoint

Paulo Ferrinho, Cláudia Conceição, André Rosa Biscaia, Inês Fronteira et Ana Rita Antunes

Un regard nord-américain sur les réformes européennes

- Policy fixes, public funds, and political frustration An American researcher looks at European health reform

Lawrence D. Brown