Health systems should be publicly funded and publicly provided

Modi, Neena; Clarke, Jonathan; McKee, Martin

doi:10.1136/bmj.k3580

Cited by 14 publications

(11 citation statements)

References 29 publications

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“…Besides, concerns over medical malpractice litigation have led to "defensive medicine" with a low threshold for diagnostic testing, including imaging [35]. On the other hand, in a universal health system, such as in Finland and the UK, health services are primarily funded through public expenditure, and care is provided without direct benefit to health professionals but rather an inclination to contain costs and limit tests [36]. There is also less fragmentation in patient care, which minimizes imaging rates, particularly duplicate examinations [37].…”

Section: Discussionmentioning

confidence: 99%

Trends of computed tomography use among children in Finland

Abuhamed

Nikkilä

Lohi

et al. 2020

European Journal of Radiology Open

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Objectives CT is an essential diagnostic tool in health care. However, CT delivers relatively high levels of radiation which has been associated with an increased risk of childhood cancer. To address this, we evaluated patterns and time trends of CT use among children in Finland during the period in which changes in pediatric CT imaging practices were reported in several countries. Methods Data on CTs performed on children younger than 15 years were obtained from Finland’s largest eight hospitals. CT data included the period 1996–2010 with an estimated coverage of more than 80 % of pediatric CT imaging in Finland. Joinpoint regression was used for trends analysis. CT radiation doses were estimated based on a Finnish dosimetry survey. Results A total of 48,807 pediatric CTs were performed in 1996–2010. More boys (55.5 %) were scanned than girls (42.8 %). CT numbers increased up to 2002, then decreased significantly (-6.9 % per year, 95 % CI: -10.4 to -3.2) towards 2005 and to a lesser extent thereafter, particularly among younger children. All CT types decreased in recent years, except for chest, spine, and extremities. The frequency of head CTs related to the diagnoses of intracranial injury, migraine and headache decreased towards the end of the study period. The estimated annual average effective dose from the three most common CT examinations was 0.004 mSv per child in the population. Conclusions The frequency of pediatric CTs in Finland started to decrease after 2002. Apart from chest and orthopedic CTs, the utilization of pediatric CT imaging declined in recent years, most likely explained by improved awareness of medical radiation risks and reliance on alternative modalities such as MRI and ultrasound.

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Section: Discussionmentioning

confidence: 99%

Trends of computed tomography use among children in Finland

Abuhamed

Nikkilä

Lohi

et al. 2020

European Journal of Radiology Open

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“…This influence has been expressed in economic policies such as privatization, austerity, deregulation, free trade, and reductions in government spending on health and welfare systems. This increase in the role of the private sector in the economy and society has resulted in an ongoing process of privatization of welfare services-among them, healthcare-thus leading to growing health inequalities [5,6].…”

Section: Introductionmentioning

confidence: 99%

From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases

Filc

Rasooly

Davidovitch

2020

Isr J Health Policy Res

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Background: Different forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare. Main text: While in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services. Conclusions: Comparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one's local context: The failure of the Alzira model in Spain warns us of the problems of forprofit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.

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“…In 2019, the European Observatory on Health Systems and Policies in Brussels published two policy analyses on aging societies, calling for more diverse funding sources for European health systems (Cylus et al, 2019a(Cylus et al, , 2019b. Direct calls for higher taxes and more public funds have also been made by other prominent European public health figures (Modi et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Can Asia provide models for tax-based European health systems? A comparative study of Singapore and Sweden

Saltman

Yeh

Liu

2020

HEPL

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Singapore's health system generates similar levels of health outcomes as does Sweden's but for only 4.4% rather than 11.0% of gross domestic product, with Singapore's resulting health sector savings being re-directed to help fund both long-term care and retirement pensions for its elderly citizens. This paper contrasts the framework of financial risk-sharing and the configuration and management of health service providers in these two high-income, small-population countries. Two main institutional distinctions emerge from this country case comparison: (1) Key differences exist in the practical configuration of solidarity for payment of health care services, reflecting differing cultural roots and social expectations, which in turn carry substantial implications for financing long-term care and pensions. (2) Differing arrangements exist in the organization of health service institutions, in particular balancing public as against private sector responsibilities for owning, operating and managing these two countries' respective hospitals. These different structural characteristics generate fundamental differences in health sector financial and delivery outcomes in one developed country in Far East Asia as compared with a well-respected tax-funded health system in Western Europe. In the post-COVID era, as Western European policymakers find themselves forced to adjust their publicly funded health systems to (further) reductions in economic growth rates and overall tax receipts, and as the cost of the information revolution continues to rise while efforts to fund better coordinated social and home care services for growing numbers of chronically ill elderly remain inadequate, this two-country case comparison highlights a series of health system design questions that could potentially provide alternative health sector financing and service delivery strategies.

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Health systems should be publicly funded and publicly provided

Abstract: A market in healthcare increases the likelihood of inequity and exploitation, with suboptimal care for both rich and poor, say Neena Modi and colleagues

Cited by 14 publications

References 29 publications

Trends of computed tomography use among children in Finland

Trends of computed tomography use among children in Finland

From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases

Can Asia provide models for tax-based European health systems? A comparative study of Singapore and Sweden

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