Changing the Health Care System Models from Here and Abroad (1994) / Chapter Skim
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Health Care Reform: The European Experience
Health Care Reform: The European Experience
Pages 5-16
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From page 5... ...
Health-related industries are also intensifying their long-standing interest in European health affairs and regulation to adjust their marketing, production, and distribution strategies to the new realities of tightening health care regulation in European countries, and in particular to the implications of the creation in 1993 of a single European market.2 Health care management consulting firms constitute the third party with growing involvement in the European health care scene. They assist U.S.
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From page 6... ...
Health care is even more in the forefront of the political debate and election campaigns in Europe than it is in the United States.5 There is a certain irony in the fact that health policy options copied from the United States are under severe attack in The Netherlands, Spain, Poland, and in particular the United Kingdom. EUROPEAN HEALTH REFORMS IN REVIEW The first wave of major health reforms since the introduction of compulsory health insurance in Imperial Germany by Otto von Bismarck in 1883 and in the United Kingdom by Winston Churchill and Lloyd George in 1911 occurred in Europe toward the end of World War II.
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From page 7... ...
Medical encounters and medical technology were considered ineffective unless proven otherwise. Doctors and hospitals were branded "bad for your health."6 The vaunted savings of free access had not materialized.
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With limited understanding of the dynamics of health economics and the virtual absence of the sophisticated health data and management information systems, important policy instruments like need-based planning, global budgeting, target budgeting, incentive-based physician payment systems, and various forms of cost-sharing were introduced. A third wave of major health reforms started toward the end of the 1980s.
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From page 9... ...
In Spain, the Abril Committee evaluating the Spanish health care system in view of reforms met great resistance from Parliament regarding its proposals for privatization. The baseline situation at the start of the current reforms in Europe varies from country to country, given the different health care systems and social/economic environments.
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From page 10... ...
against the Labour Party in angry exchanges over their respective health budget calculations and over the broader question of whether taxes in the United Kingdom would be lowered or raised. The governments of Belgium and The Netherlands have issued new, lower caps on their health care budgets in their attempts to reach the requirements for Monetary Union.
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From page 11... ...
reforms. In the opposite direction, utilization monitoring of all clinical procedures, linked to financial penalties for trespassing preset practice guidelines, are introducing costly microregulation as a heavy "visible hand" in the health economics of medical cultures like those in Belgium, France, and Germany, which were traditionally bent toward clinical autonomy.
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From page 12... ...
National responsibility for health policy and resource allocation decisions these days is being eroded. Choices in health care delivery and even revenue raising are gradually being claimed and redistributed away from the traditional national centers of power.
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From page 13... ...
In practice, it will legitimate and focus the indirect and scattered actions undertaken so far. The Council of Europe, which is an intergovernmental cooperative of more than just EC countries and whose size was recently increased by the entry of a number of Central European countries, has contributed to health policy through binding agreements in the areas of human rights, patient rights, and bioethics.
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In the West, organized medicine paradoxically reverts to advocating stringent planning and the status quo when confronted with competing options. In the East, unrealistic hopes in the market economy fuel an open rebellion against the regulation of health care.
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The policies of hospital development, workforce development, and more recently, cost containment have all been overshooting their targets. Again and again, future policy designs ignore the lingering effects of previous policies and fail to include required checks and balances.
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From page 16... ...
1978. National Health Insurance and Health Resources.
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