First published in 1999, this volume aims to describe and analyse the experience of cost containment in Europe over the last fifteen years in order to understand that experience and to determine, as best we can, which methods were successful and which were not. Part I provides an overview of healthcare in the European Union, an overview of recent expenditure trends. Part II complements the first, examining in detail cost containment policies in each EU Member State. The country-based chapters refer to developments up to mid-1997.
As the largest expenditure category of the health systems in both industrialised and developing countries, hospital care provision has been the focus of reforms over recent decades. This publication reviews recent trends in hospital policy reforms and options around the world; and includes case studies which offer insights into lessons learned. Issues considered include: differences in income levels, cultural settings and market environments; organisational changes such as increased management autonomy and privatisation; the need for parallel reforms and effective evaluation mechanisms.
This volume examines the two models of health care reform - managed competition and internal markets - that are increasingly becoming the dominant paradigm in European and North American policy.
Examines the forces for change in health politics and tries to predict the future for health politics in the next decade. Examines the issues surrounding many areas including the impact of market reforms; gp fundholding; resource allocation issues; rights and accountability; funding for the health service and the private finance initiative.
The modern industrial states desperately need more competition in order to generate growth and employment. Although the European Union pushed its member states to open several sectors to competition, there is much left to be done. At the same time powerful interest groups try to avoid or to reduce competition on European labour markets, in the health systems, in the transport and energy sector, in public services, and in many other areas. This book shows that there is much to be gained from intensifying competition and that especially consumers would benefit. One task is to lay a sound basis for the application of competition. The other task is to implement and guarantee competition. The authors cover both issues.
The problems arising from the existence of asymmetric information in public decision making have been widely explored by economists. Most of the traditional analysis of public sector activities has been reviewed to take accountofthe possible distortions arising from an asymmetric distribution of relevant information among the actors of the public decision-making process. A normative approach has been developed to design incentive schemes which tackle adverse selection and moral hazard problems within public organisations: our understanding of these problems is now much better, and some of the mechanisms designed have had important practical implications. While this analysis is still under way in many fields of public economics, as the papers by Jones and Zanola, and Trimarchi witness, a debate is ongoing on the possible theoretical limitations ofthis approach and on its actual relevance for public sector activities. This book encompasses different contributions to these issues, on both theoretical and practical areas, which were firstly presented at a conference in Catania. The innermost problem in the current discussion arises from the fact that this normative analysis is firmly rooted in the complete contracting framework, with the consequence that, despite the analytical complexities of most models, their results rely on very simplified assumptions. Most complexities of the organisation of public sector, and more generally, of writing "contracts", are therefore swept away.
Great progress has been made in recent years in securing better access and financial protection against the cost of illness through collective financing of health care. Managing scarce resources effectively and efficiently is an important part of this story. Experience has shown that, without strategic policies and focused spending, the poor are likely to get left out. The use of purchasing to enhance public sector performance is well-documented in other sectors. Extension to the health sector of lessons from this experience is now successfully implemented in many developing countries. Public.
There has been an international move towards the creation of explicit markets in health care, in which the purchase of care is separated from provision. While the creation of such markets has undeniably led to improvements in certain aspects of health care, it has also raised important issues that have yet to be resolved - for example, is an escalation of management costs an inevitable consequence of the introduction of a market in health care? What sort of information is needed to make the market function efficiently? Can a market-based system be compatible with society's objectives relating to equity and solidarity? The UK government is introducing reforms to the internal health care market in the UK National Health Service which seek to address concerns such as these, and this book comprises a series of commentaries on their plans from a group of leading health economists. Authors examine the contribution of economics to the debate on the reforms, while seeking to make the analysis accessible to a general audience. Reforming Markets in Health Care is recommended reading for students and researchers of health policy and health economics, as well as health professionals and policy makers at all levels in the health services.
"It would be difficult to overstate the standing of the authors. Many HERU alumni are among the most highly esteemed health economists in the world." —Steve Morgan, University of British Columbia This is a series of essays to mark the 25 anniversary of HERU. Existing and former HERU staff write about their special interests and work records. This book addresses many current policy issues which exist in the Scottish (and English) National Health System. HERU is one of the leading health economic institutes in the UK Contributors are all distinguished members of the health economics community Covers a wide range of issues that are relevant to the application of health economics now and into the future.
NHS reform continues to be a topical yet contentious issue in the UK. Reforming healthcare: What's the evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics. It explores work considering the Conservative internal market of the 1990s and New Labour's healthcare reorganizations, including its attempts at performance management and the reintroduction of market-based reform from 2004 to 2010. It then considers the implications of this research for current debates about healthcare reorganization in England, and internationally. As the most up-to-date summary of what research says works in English healthcare reform, this essential review is aimed at anyone interested in the wide-ranging debates about health reorganization, but especially students and academics interested in social policy, public management and health policy.
