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The core of existing healthcare typologies is the public—private mix in the three areas of funding, provision and regulation of healthcare services. This article aims to contribute to the debate by adding ‘healthcare access’ as an important dimension for comparing healthcare systems. In contrast to previous analyses, I extend the concept of access by looking at regulative aspects and financial incentives that shape entry and reception of care. Based on empirical indicators for three different dimensions of healthcare access — gatekeeping, cost sharing and supply — a cluster analysis is performed that yields four access regime types: financial incentive states; strong gatekeeping/low supply states; weakly regulated/high supply states; and mixed regulation states. The countries clustered in the access regimes show a different pattern than typologies based on other system indicators. This suggests that previously used dimensions for comparison do not sufficiently capture patients’ access to healthcare.

Negative implications for mental health (in terms of depressive feelings) have been limited to some of the most strongly affected countries, while in the majority of Europe persons have felt less depressed over the course of the recession. Health inequalities have persisted in most countries during this time with little influence of the recession. Particular attention should be paid to the mental health of the inactive and the precariously employed.

Objective:To assess a comprehensive multicomponent intervention against a low intensity intervention for promoting physical activity in chronic low back pain patients.Design:Randomised controlled trial.Setting:Inpatient rehabilitation and aftercare.Subjects:A total of 412 patients with chronic low back pain.Interventions:A multicomponent intervention (Movement Coaching) comprising of small group intervention (twice during inpatient rehabilitation), tailored telephone aftercare (twice after rehabilitation) and internet-based aftercare (web 2.0 platform) versus a low level intensity intervention (two general presentations on physical activity, download of the presentations).Main measures:Physical activity was measured using a questionnaire. Primary outcome was total physical activity; secondary outcomes were setting specific physical activity (transport, workplace, leisure time) and pain. Comparative group differences were evaluated six months after inpatient rehabilitation.Results:At six months follow-up, 92 participants in Movement Coaching (46 %) and 100 participants in the control group (47 %) completed the postal follow-up questionnaire. No significant differences between the two groups could be shown in total physical activity (P = 0.30). In addition to this, workplace (P = 0.53), transport (P = 0.68) and leisure time physical activity (P = 0.21) and pain (P = 0.43) did not differ significantly between the two groups. In both groups, physical activity decreased during the six months follow-up.Conclusions:The multicomponent intervention was no more effective than the low intensity intervention in promoting physical activity at six months follow-up. The decrease in physical activity in both groups is an unexpected outcome of the study and indicates the need for further research.

Gatekeeping and provider choice have become central in health policymaking within the last two decades. This article contributes to the debates in two ways: first, it provides an extended review of evidence on the impact of gatekeeping and provider choice on efficiency, costs, quality, equality and patient empowerment; and second, it empirically analyses regulations and identifies common trends in healthcare reforms in OECD countries since 1990. More than half of the countries analysed have established gatekeeping systems, while a smaller number provides free access to secondary care. The study discovers a trend towards strengthening gatekeeping regulations within free access countries. Free choice of provider is the standard in the OECD, where only a small number of countries restrict provider choice. The article identifies a diverging trend of reforms, with some traditionally restrictive countries offering more provider choice and other countries limiting the choice of providers as a result of managed care reforms.