Changing choices in health care: implications for equity, efficiency and cost

Abstract

: Although choice may be seen as an end in itself, the papers included in this special issue of Health Economics, Policy and Law, examine choice policies in European systems of health care, which aim to be effective instruments for ameliorating the systemic pressures from the iron triangle of equity, efficiency, and cost. Three papers consider the nature of differences between and within countries following the Beveridge and Bismarck models of financing and organising the delivery of care, and how choices are changing within different systems. Within countries following the Beveridge model, current policies in England, Denmark and Sweden emphasise increasing patient choice of provider. Within countries following the Bismarck model, current policies in France and Germany seek to restrict choice of specialists by introducing 'soft' gatekeeping; and in the Netherlands there is a system of managed competition with choice of insurer that, in principle, allows insurers to contract selectively

Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity

“…A second major finding is the confirmation that social insurance systems paid much more attention to efficiency/cost-containment objectives. This is consistent with a body of academic commentary which highlights cost-control/efficiency as more pressing objectives for various policy actors in social insurance systems [8,9,16]. It is important to note here that many proposals that were coded as addressing cost-containment/efficiency could be construed as proposals for cost-shifting from one set of actors to another.…”

“…A great deal of recent comparison of tax-based and social insurance systems draws attention to the systemic advantages and disadvantages of each type. Social insurance systems find it more difficult to achieve cost-containment [7][8][9], whereas tax-based systems appear to have characteristic problems achieving timely access to health care services [7,8]. This literature suggests that different systems of health funding have different 'genetic dispositions' to suffer particular illnesses.…”

User choice in Swedish eldercare – conditions for informed choice and enhanced service quality

“…Hence, a central mechanism in provider choice models is the exit option, which makes providers aware of the risk of losing customers if the users become discontent (Friedman and Friedman, 1980;Le Grand, 2009). Previous research on the effects of provider choice has focused primarily on efficiency, and most studies have been conducted in the area of health care (Bevan et al, 2010;Cellini et al, 2000;Cooper et al, 2010). Studies examining the effects on service quality are fewer.…”

Da organização do sistema à fragmentação do cuidado: a percepção de usuários, médicos e farmacêuticos sobre o Componente Especializado da Assistência Farmacêutica

“…Introdução Os medicamentos têm papel importante na atenção à saúde como ferramentas que permitem prevenir e tratar doenças. No entanto, os custos crescentes das novas alternativas terapêuticas tornaram-se um desafio para os sistemas de saúde (BRASIL, 2011a), inclusive nos países desenvolvidos (LU; WILLIAMS; DAY, 2007;BEVAN;HELDERMAN;WILSFORD, 2010). No intuito de garantir o acesso equitativo e o uso racional dos medicamentos de alto custo, os países têm estabelecido políticas que incluem critérios explícitos de tratamento (protocolos e diretrizes clínicas) e a criação de comissões para a avaliação de tecnologias em saúde.…”