TY - CHAP

T1 - The Changing Public - Private-Mix in OECD Healthcare Systems

AU - Rothgang, Heinz

AU - Cacace, Mirella

AU - Frisina, Lorraine

AU - Schmid, Achim

PY - 2008

Y1 - 2008

N2 - The economic recession following the oil price shocks of the 1970s triggered a broad range of cost containment measures in social polices throughout the OECD world. Health care was no exception. Globalization, demographic change and advancements in medical technology have strengthened the need for reforms that assure both the quality and efficiency of health-care systems while at the same time guaranteeing equal access to services (OECD, 1994). The pertinent question to be dealt with in this contribution is how the role of the state and the market in attaining these challenging and somewhat contradictory objectives, has changed over time. Evidence suggests that although common challenges are experienced, the responses to various socio-economic pressures have differed considerably across healthcare systems (Tuohy, 1999; Rothgang et al., 2006). Starting in the 1990s, for example, we observe that in many predominately publicly financed health-care systems market-oriented health-care reforms have been implemented or proposed (van de Ven, 1996; Freeman and Schmid, forthcoming), whereas in countries with private insurance systems access to health care and the introduction of universal health insurance have gained political salience (Skocpol, 1994; Zweifel, 2000). This contribution focuses particularly on the ‘hybridization’ of health-care systems induced by the changing public–private mix. In order to capture these developments systematically, we differentiate between dimensions of health-care systems: financing, service provision and regulation.

AB - The economic recession following the oil price shocks of the 1970s triggered a broad range of cost containment measures in social polices throughout the OECD world. Health care was no exception. Globalization, demographic change and advancements in medical technology have strengthened the need for reforms that assure both the quality and efficiency of health-care systems while at the same time guaranteeing equal access to services (OECD, 1994). The pertinent question to be dealt with in this contribution is how the role of the state and the market in attaining these challenging and somewhat contradictory objectives, has changed over time. Evidence suggests that although common challenges are experienced, the responses to various socio-economic pressures have differed considerably across healthcare systems (Tuohy, 1999; Rothgang et al., 2006). Starting in the 1990s, for example, we observe that in many predominately publicly financed health-care systems market-oriented health-care reforms have been implemented or proposed (van de Ven, 1996; Freeman and Schmid, forthcoming), whereas in countries with private insurance systems access to health care and the introduction of universal health insurance have gained political salience (Skocpol, 1994; Zweifel, 2000). This contribution focuses particularly on the ‘hybridization’ of health-care systems induced by the changing public–private mix. In order to capture these developments systematically, we differentiate between dimensions of health-care systems: financing, service provision and regulation.

KW - Health sciences

KW - National Health Service

KW - Service Provision

KW - Dental Service

KW - Sickness Fund

KW - Private Provision

UR - https://www.palgrave.com/gp/book/9780230205789

U2 - 10.1057/9780230227392_8

DO - 10.1057/9780230227392_8

M3 - Contributions to collected editions/anthologies

SN - 978-0-230-20578-9

SN - 978-0-230-32177-9

SP - 132

EP - 146

BT - Welfare State Transformations in Comparative Perspective

A2 - Seeleib-Kaiser, Martin

PB - Palgrave Macmillan

CY - Houndmills/Basingstoke

ER -