Social health insurance systems in western Europe

1 Edited byRichard B. SaltmanReinhard BusseJosep FiguerasSocial health insurancesystems in western EuropeSocial health insurance systems in western EuropeEdited by Saltman / Busse / FiguerasEuropean Observatory on health systems and Policies SeriesSocial health insurance systems in western Europe What are the characteristics that define a Social health insurancesystem? How is success measured in SHI systems ? How are SHI systems developing in response to external pressures?Using the seven Social health insurance countries in western Europe Austria, Belgium, France, Germany, Luxembourg, the Netherlands andSwitzerland as well as Israel, this important book reviews corestructural and organizational dimensions, as well as recent reformsand innovations.

2 Covering a wide range of policy issues, the book: Explores the pressures these health systems confront to be moreefficient, more effective, and more responsive Reviews their success in addressing these pressures Examines the implications of change on the structure of SHIs asthey are currently defined Draws out policy lessons about past experience and likely futuredevelopments in Social health insurance systems in a manner usefulto policymakers in Europe and elsewhereSocial health insurance systems in western Europewill be of interest tostudents of health policy and management as well as health managersand policy editorsRichard B. Saltmanis Professor of health Policy and Management atthe Rollins School of Public health , Emory University in Atlanta, USAand Research Director of the European Observatory on health Systemsand Busseis Professor and Department Head of health CareManagement at the Technische Universit t in Berlin, Germany andAssociate Research Director of the European Observatory on HealthSystems and Figuerasis Head of the Secretariat and Research Director of theEuropean Observatory on health systems and Policies and Head ofthe European Centre for health Policy, Brussels, WHO Regional Officefor contributorsHelmut Brand, Jan Bultman, Reinhard Busse, Laurent Chambaud,David Chinitz, Diana Delnoij, Andr P.

3 Den Exter, Aad A. de Roo,Anna Dixon, Isabelle Durand-Zaleski, Hans Dubois, JosepFigueras, Bernhard Gibis, Stefan Gre , Bernhard J. G ntert, JeanHermesse, Maria M. Hofmarcher, Martin McKee, Pedro W. Koch-Wulkan, Claude Le Pen, Kieke Okma, Martin Pfaff, Richard , Wendy van der Kraan, J rgen Wasem, ManfredWildner, Matthias design: Barker/Hilsdon9780335213634 ISBN health 6/30/04 2:43 PM Page 1 Series editors introductionEuropean national policy makers broadly agree on the core objectives that theirhealth care systems should pursue. The list is strikingly straightforward: uni-versal access for all citizens, effective care for better health outcomes, efficientuse of resources, high-quality services and responsiveness to patient concerns.

4 Itis a formula that resonates across the political spectrum and which, in various,sometimes inventive configurations, has played a role in most recent Europeannational election this clear consensus can only be observed at the abstract policy level. Oncedecision makers seek to translate their objectives into the nuts and bolts ofhealth system organization, common principles rapidly devolve into divergent,occasionally contradictory, approaches. This is, of course, not a new phenom-enon in the health sector. Different nations, with different histories, culturesand political experiences, have long since constructed quite different insti-tutional arrangements for funding and delivering health care diversity of health system configurations that has developed in responseto broadly common objectives leads quite naturally to questions about theadvantages and disadvantages inherent in different arrangements, and whichapproach is better or even best given a particular context and set of concerns have intensified over the last decade as policy makers havesought to improve health system performance through what has become aEuropean- wide wave of health system reforms.

5 The search for comparativeadvantage has triggered in health policy as in clinical medicine increasedattention to its knowledge base, and to the possibility of overcoming at leastpart of existing institutional divergence through more evidence- based healthpolicy volumes published in the European Observatory series are intended toprovide precisely this kind of cross- national health policy analysis. Drawing onan extensive network of experts and policy makers working in a variety ofacademic and administrative capacities, these studies seek to synthesize theavailable evidence on key health sector topics using a systematic volume explores the conceptual background, outcomes and lessonslearned about the development of more equitable, more efficient and moreeffective health care systems in Europe .

6 With this focus, the series seeks tocontribute to the evolution of a more evidence- based approach to policy formu-lation in the health sector. While remaining sensitive to cultural, Social andnormative differences among countries, the studies explore a range of policyalternatives available for future decision making. By examining closely both theadvantages and disadvantages of different policy approaches, these volumesfulfil a central mandates of the Observatory: to serve as a bridge between pureacademic research and the needs of policy makers, and to stimulate the devel-opment of strategic responses suited to the real political world in which healthsector reform must be European Observatory on health systems and Policies is a partnershipthat brings together three international agencies, six national governments, tworesearch institutions and an international non- governmental organization.

7 Thepartners are as follows: the World health Organization Regional Office forEurope, which provides the Observatory secretariat; the governments of Belgium,Finland, Greece, Norway, Spain and Sweden; the European Investment Bank;the Open Society Institute; the World Bank; the London School of Hygiene &Tropical Medicine and the London School of Economics and Political addition to the analytical and cross- national comparative studies pub-lished in this Open University Press series, the Observatory produces HealthCare systems in Transition (HiTs) profiles for the countries of Europe , thejournal Eurohealth and the newsletter Euro Observer. Further informationabout Observatory publications and activities can be found on its Figueras, Martin McKee, Elias Mossialos and Richard B.

8 SaltmanSeries editors introductionxiEuropean Observatory on health systems and Policies SeriesEdited by Josep Figueras, Martin McKee, Elias Mossialos and Richard B. SaltmanSocial health insurancesystems in western EuropeEdited byRichard B. Saltman,Reinhard Busse andJosep FiguerasOpen University Press Open University PressMcGraw-Hill EducationMcGraw-Hill HouseShoppenhangers RoadMaidenheadBerkshireEnglandSL6 2 QLemail: wide web: Two Penn Plaza, New York, NY 10121-2289, USAF irst published 2004 Copyright World health Organization 2004 on behalf of the European Observatoryon health systems and PoliciesThe views expressed in this publication are those of the editors and contributors anddo not necessarily represent the decisions or the stated policy of the participatingorganizations of the European Observatory on health systems and rights reserved.

9 Except for the quotation of short passages for the purpose ofcriticism and review, no part of this publication may be reproduced, stored in aretrieval system , or transmitted, in any form or by any means, electronic, mechanical,photocopying, recording or otherwise, without the prior written permission of thepublisher or a licence from the Copyright Licensing Agency Limited. Details ofsuch licences (for reprographic reproduction) may be obtained from the CopyrightLicensing Agency Ltd of 90 Tottenham Court Road, London, W1T catalogue record of this book is available from the British LibraryISBN 0 335 21363 4 (pb) 0 335 21364 2 (hb)Library of Congress Cataloging-in-Publication DataCIP data applied forTypeset by RefineCatch Limited, Bungay, SuffolkPrinted in Great Britain by Bell and Bain Ltd, GlasgowList of contributorsHelmut Brand is Director of the Institute of Public health NRW in Bielefeld, Bultman is Lead health Specialist at the World Bank in Washington DC, Busse is Professor and Department Head of health Care Management atthe Technical University in Berlin, Germany, and Associate Research Directorof the European Observatory on health systems and Chambaud is President of the French Society of Public health andDirector of the Regional Department of health and Social Affairs (DRASS)

10 OfFranche-Comt in Besan on, Chinitz is Senior Lecturer at the Hebrew University-Hadassah School ofPublic health in Jerusalem, Delnoij is Senior Research Coordinator at the Netherlands Instituteof health Services Research (NIVEL) in Utrecht, the A. de Roo is Professor of Strategic health Care Management at the Faculty ofSocial and Behavioural Sciences, Tilburg University, the P. den Exter is Assistant Professor of health Law at the Department of HealthPolicy and Management, Erasmus University in Rotterdam, the Dixon is Lecturer in European health Policy at the Department of SocialPolicy, London School of Economics and Political Science in London, Dubois is Research Officer of the European Observatory on HealthSystems and Policies in Madrid, Durand-Zaleski is Assistant Professor at the Department of Public Healthof the Henri Mondor Hospital in Paris, Figueras is Head of the Secretariat and Research Director of the EuropeanObservatory on health systems and Policies and Head of the European Centrefor health Policy, Brussels.