Implementation of health care reforms in the Bismarckian systems: unequal capacities
Catrice-Lorey, Antoinette
Implementation of health care reforms in the Bismarckian systems: unequal capacities - 2006.
72
Implementation is often neglected in comparative analyses of the regulation of health care systems and expenditure. Taking this aspect into account reintroduces the national diversity of the reform paths, whereas approaches focused on the institutional models and financial data blur the differences and highlight international transfers of ideas and common economic constraints. This article compares the implementation of reforms aiming to regulate healthcare expenditure in countries with Bismarckian systems (France, Germany, the Netherlands), revealing unequal capacities to implement change, depending on the players and, in particular, the relationship between the state and health care insurance providers. The study distinguishes structural reforms, aimed at modifying the original architecture of the system to benefit new players, and management reforms, which try to depart from the previous opaque management style and promote a medico-economic approach combining managerial rigor with medical quality. Finally, it identifies three levels in the carrying out of reforms, each requiring specific conditions for their implementation: political arbitration between the financial and social spheres, the withdrawal of the state in favour of a regionalisation or privatisation of the systems’ management and, finally, the introduction of new models of medico-economic management.
Implementation of health care reforms in the Bismarckian systems: unequal capacities - 2006.
72
Implementation is often neglected in comparative analyses of the regulation of health care systems and expenditure. Taking this aspect into account reintroduces the national diversity of the reform paths, whereas approaches focused on the institutional models and financial data blur the differences and highlight international transfers of ideas and common economic constraints. This article compares the implementation of reforms aiming to regulate healthcare expenditure in countries with Bismarckian systems (France, Germany, the Netherlands), revealing unequal capacities to implement change, depending on the players and, in particular, the relationship between the state and health care insurance providers. The study distinguishes structural reforms, aimed at modifying the original architecture of the system to benefit new players, and management reforms, which try to depart from the previous opaque management style and promote a medico-economic approach combining managerial rigor with medical quality. Finally, it identifies three levels in the carrying out of reforms, each requiring specific conditions for their implementation: political arbitration between the financial and social spheres, the withdrawal of the state in favour of a regionalisation or privatisation of the systems’ management and, finally, the introduction of new models of medico-economic management.
Réseaux sociaux