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Health care systems coverage and cost: A comparative analysis of European Health care systems

We will discuss 3 questions:. I. How did European health care systems extend coverage? II. How do various health care systems work?III. Is universal coverage more costly?. The message. The most universal and egalitarian Health care systems are also?the cheapest!And (under certain conditions) the most cost-efficient!!!But you need to be a patient patient?.

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Health care systems coverage and cost: A comparative analysis of European Health care systems

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    1. Health care systems coverage and cost: A comparative analysis of European Health care systems Bruno Palier, Ph.D. Chargé de recherches du CNRS Centre d’Étude de la Vie Politique Française (CEVIPOF) Visiting Scholar at Northwestern University

    2. We will discuss 3 questions: I. How did European health care systems extend coverage? II. How do various health care systems work? III. Is universal coverage more costly?

    3. The message The most universal and egalitarian Health care systems are also… the cheapest! And (under certain conditions) the most cost-efficient!!! But you need to be a patient patient…

    4. I. Towards universal coverage History of the purposes of health care policies: 1. To aid the sick on low incomes 2. To guarantee a substitute income for salaried workers suffering from illness 3. To ensure (equal) access to healthcare for all

    5. I. Towards Universal coverage Two main solutions in Europe: A unified, uniform Public Service : - The British National Health Service (1948) - The Swedish progressive strategy (1955, 1969) Health insurance for all: - The French case (19 different regimes + CMU)

    6. Two types of Universal Healthcare Systems The national health system (Sweden, Norway, Denmark, Finland, Great Britain, Italy, Spain, and in part Portugal, Greece, Canada, Australia and New Zealand) 2. The health insurance system (Germany, France, Austria, Belgium, Luxembourg, and to a lesser extent Japan, the Netherlands and certain countries in Central and Eastern Europe). A third type is not universal (perhaps not even a system!!!) 3. The liberal/residual healthcare system (that of the United States).

    7. II. Different modes of functioning, different problems Four dimensions: Access The services The financing The organisation and regulation

    8. Different modes of functioning, different problems Access to the healthcare system Access to the system : for all or for the insured: Problems of exclusion in health insurance systems. Access to healthcare providers: free circulation or control: Problems of choice and waiting time in the NHS.

    9. II. Different modes of functioning, different problems 2. The services Public or private providers? Private supply in ambulatory sectors of health insurance systems, GP and specialists What costs are paid for by the system?

    11. II. Different modes of functioning, different problems 3. The financing The financing of the systems. Tax, general income (redistribution) or local taxes (inequalities?) Social contribution and the problems of labour cost The co-payment and other user fees The financing of the providers Remuneration of doctors. The “non incentive” wages or flat rate remunerations The “inflationary” fee for service The funding of hospitals: From fixed budgets to activity based financing.

    12. II. Different modes of functioning, different problems 4. The organisation and regulation of the system Three models of regulation: - Regulation by the government (authoritative, limitative). - The negotiated regulation (inflationary) - Regulation by the market (inequalities, may be tough)

    13. III. Different Performances Four main criteria for assessing Health Care Systems: - Equality - Cost control - Health of the population - Users’ satisfaction (citizens, doctors, patients)

    14. III. Different performances Social goals : inequalities Same access for all versus choice Social inequalities of Health : the role of co-payment.

    15. III. Different performances Cost control: two elements Total level of expenditure Expenditure development

    17. Development of health expenditure

    18. III. Performances Cost efficiency: The health of the population compared to the sums spent. Sweden spends the average, and has the best Health care system in the world!!!

    19. Population health

    21. Yes but… The middle class does not want to have to wait The middle class wants to choose!

    22. Citizens’ Satisfaction with their Health care system

    24. The quadrilemna of healthcare reforms:

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