Reforms in German, French and British health systems
DOI:
https://doi.org/10.5020/18061230.2018.8775Keywords:
Health Systems, Health Care Economics and Organizations, Health Care Reform.Abstract
Objectives: To map the reforms experienced in German, French and British health systems over the period 1980, 1990 and 2000, as well as to present the recent modifications by means of the economic crisis of 2008/2009. Methods: This is an original article based on the approach of the political economy method, through the historical description of change processes in the commodification of the health systems, with qualitative characteristics. For examination of the series of changes seen in the health systems, a comparative analysis is used, addressing these aspects: cost-containment mechanisms; instruments of commodification; decentralization of management and allocation of resources; regulation; financing; and coverage. Results: Over the analyzed decades, the three health systems experienced reforms that involved: new forms of financing; expansion of co-payments, private insurance, public-private partnerships, outsourcing of auxiliary services, private patient care in the public network; incorporation of the private sector in the provision of services; private management of public institutions; increased competition between public service providers; payment by results in hospitals. Conclusion: The reforms generated more commoditized and cost-oriented systems, but in which the social demand forced the extension of coverage, with increasing use of fiscal resources for their financing.Downloads
References
Palier B, Surel Y, Bossy L, Boussaguet L, Chabalier D, Devineau J; et al. L`explication du changement dans l'analyse des politiques publiques: identification, causes et mecanismes. Paris: L'Harmattan, coll. Logiques politiques; 2010.
Hassenteufel P, Palier B. Towards neo-bismarckian health care states? Comparing health insurance reforms in bismarckian welfare systems. Soc Policy Adm. 2007;41(6):574-96.
Hassenteufel P, Smyrl M, Genieys W, Moreno-Fuentes FJ. Programmatic Actors and the transformation of European Health care States. J Health Polit Policy Law. 2010;35(4):517-38.
Maarse H. The privatization of health care in Europe: an eight-country analysis. J Health Polit Policy Law. 2006;31(5):981-1014.
André C, Batifoulier P, Jansen-Ferreira MR. Une nouvelle grille d'analyse des processus de privatisation en Europe. In: Abecassis P, Coutinet N, editores. Economie sociale: crises et renouveaux. Louvain la Neuve: Presses Universitaires de Louvain; 2015. p. 95-110.
Paulo J Neto, Braz M. Economia Política: uma introdução crítica. São Paulo: Cortez; 2006.
Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 13a ed. São Paulo: Hucitec; 2013.
Klein R. The new politics of the NHS. 4a ed. Prentice Hall: Pearson Education; 2001.
Tabuteau D. Démocratie Sanitaire: les nouveaux défis de la politique de santé. Paris: Odile Jacob; 2013.
Batifoulier P. Capital santé: quand le patient devient client. Paris: La Découverte; 2014.
Barbier JC. The French social protection system in the throes of reform (1975-2007). Documents de Travail du Centre d´Economie de la Sorbonne. Paris: Maison des Sciences Économiques; 2007.
OECD. OECD Health Statistics [Internet]. 2017; [acesso 2015 dez 17]. Disponível em: http://www.oecd.org/els/health-systems/health-data.htm.
Busse R, Blümel M. Germany: Health system review. Health Syst Transit. 2014;16(2):1-296.
Théret B. The Place of national systems of social protection and political representation in socio-economic regulation. Evol Inst Econ Rev. 2011;7(2):177-208.
Gerlinger T, Schmucker R. A Long farewell to the Bismarck System: incremental change in the German Health Insurance System. German Policy Stud. 2009;5(1):3-20.
Hinrichs K. A Social insurance state withers away. Welfare state reforms in Germany – or: attempts to turn around in a cul-de-sac. In: Palier B, editor. A Long Goodbye to Bismarck? The Politics of Welfare Reform in Continental Europe. Amsterdam: Amsterdam University Press; 2010. p. 45-72.
Pellet R. L’évolution du financement de l’assurance-maladie: bilan et perspectives. Rev Econ Financ. 2004;76(3):87-127.
Saltman RB, Bankauskaite V, Vrangbbaek K. editores. Decentralization in health care: strategies and outcomes. European Observatory on Health Care Systems Series. New York: McGraw-Hill; 2007.
Mays N, Dixon A, Jones L, editores. Understanding New Labour’s market reforms of the English NHS. Londres: The King’s Fund; 2011.
Catrice-Lorey A, Steffen M. Implementation of health care reforms in the bismarckian systems: unequal capacities. Revue française des affaires sociales. 2006;6-7:163-82.
Hassenteufel P. Les systèmes de santé entre conceptualisation économique et reconceptualisation politique. Socio-logos [Internet]. 2014 [acesso em 2014 Mai 01]; 9. Disponível em: http://socio-logos.revues.org/2812
Stolpe M. Reforming Health Care – The German Experience. IMF Conference Public Health Care Reforms: Challenges and Lessons for Advanced and Emerging Europe [Internet]. Paris: Kiel Institute for the World Economy; 2011. [acesso em 2014 Jun 10]. Disponível em: https://www.imf.org/external/np/seminars/eng/2011/paris/pdf/stolpe.pdf
Rochaix L, Wilsford D. State autonomy, policy paralysis: paradoxes of institutions and culture in the French health care system. J Health Polit Policy Law. 2005;30(1-2): 97-119.
Allen P. An economic analysis of the limits of market based reforms in the English NHS. BMC Health Serv Res. 2013;13(Suppl 1):S1.
Chadelat JF. Les enjeux du financement de la santé. Revue française d´administration publique. 2005;1(113):65-73.
Webster C. The National Health Service: a political history. New York: Oxford University Press; 1998.
André C, Hermann C. Privatisation and Marketisation of Health Care Systems in Europe. In: Hermann C, Huffschmid J, editores. Privatization against the European Social Model: a critique of European policies and proposal for alternatives. Hampshire: Palgrave MacMillan; 2009. p. 129-144.
Poullier JP, Sandier S. France. Duke University Press. J Health Polit Policy Law. 2000;25(5):899-905.
Duval J. Le mythe du “trou de la Sécu”. Paris: Raisons d’Agir; 2007.
Eurostat. General government gross debt. 2017; [acesso em 2018 Jan 9]. Disponível em: http://ec.europa.eu/eurostat/web/products-datasets/-/teina230
Aglietta M. Zona do Euro. Qual o Futuro? São Paulo: Ideias & Letras; 2013.
Aglietta M. Europe. Sortir de la crise et inventer l’avenir. Paris: Michalon Éditeur; 2014.
Giovanella L, Stegmüller K. Crise financeira europeia e sistemas de saúde: universalidade ameaçada? Tendências das reformas de saúde na Alemanha, Reino Unido e Espanha. Rio de Janeiro: Cad Saúde Pública. 2014;30(11):1-19.
Brunn M, Brigham KB, Chevreul K, Hernández-Quevedo C. The impact of the crisis on the health system and health in France. In: Maresso A, Mladovsky P, Thomson S, Sagan A, Karanikolos M, Richardson E; et al., editores. Economic crisis, health systems and health in Europe. European Observatory on Health Systems and Policies, Observatory Studies Series. 2015;41:75-101.
Henke KD, Quentin W. Germany. In: Maresso A, Mladovsky P, Thomson S, Sagan A, Karanikolos M, Richardson E; et al., editores. Economic crisis, health systems and health in Europe. European Observatory on Health Systems and Policies, Observatory Studies Series. 2015;41:387-389.
Powell M, Miller R. Privatizing the English National Health Service: an irregular verb? J Health Polit Policy Law. 2013;38(5):1051-9.
Mays N. Introduction to the English health system and NHS: current reforms and ‘hot’ issues. London: UNC Gillings School of Global Public Health; 2014.
