The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

No abstract

No abstract

General practitioner (GP) care in Germany is characterized by a disparate distribution of GPs. There is considerable oversupply in many urban areas while there is undersupply in many rural regions. Centralized planning of GP capacities so far has not been able to ameliorate this unequal distribution. What is more, several health policy reforms have not been able to make capacity planning more effective. We suggest a framework for more effective allocation of GP resources by decentralizing capacity planning to the level of local municipalities.

No abstract

Economic behaviour as leitmotiv in health policy in Germany and its consequences for prevention and health promotionO agir econômico como motor da política de saúde na Alemanha: consequências para a prevenção e promoção da saúde

No abstract

ResumoA atenção primária à saúde (APS) como base para a construção de redes coordenadas de atenção e para garantia do acesso universal enfrenta os novos desafios demográficos e epidemiológicos com o envelhecimento populacional, as mudanças nas estruturas familiares e prevalência de agravos crônicos que exigem intervenções de diversos serviços com interdependência organizacional e demandam coordenação. O objetivo deste artigo é apresentar um panorama e tendências das reformas APS na Europa ocidental a partir de três casos exemplares: Alemanha, Espanha e Inglaterra (Reino Unido-RU). Para tanto, inicia com breve panorama dos sistemas de saúde em seguida descreve a organização da APS e analisa as principais reformas nos três países. Após a descrição das tendências nos sistemas apresentados é possível perceber que a APS adquire também importância no debate da universalidade. A garantia da universalidade tem alcançado proeminência no debate internacional (OMS) e tem sido reiterada como estratégia para alcance da cobertura universal. AbstractThe primary health care (PHC) as the basis for the construction of coordinated care networks and to guarantee universal access faces new challenges with demographic and epidemiological, population aging, changes in family structures and prevalence of chronic diseases that require interventions various services with organizational interdependence and require coordination. The objective of this paper is to present an overview of trends and APS reforms in Western Europe from three exemplary cases: Germany, Spain and England (UK). To do so, start with a brief overview of health systems and then describes the organization of PHC and analyzes the major reforms in the three countries. After describing the trends in the presented systems can realize that APS also become important in the discussion of universality. The guarantee of universality has achieved prominence in the international debate (WHO) and has been reiterated as a strategy to reach universal coverage.Descritores: atenção primária à saúde. sistemas de saúde. cobertura universal