The State and Healthcare: Comparing OECD Countries PDF
Preview The State and Healthcare: Comparing OECD Countries
Transformations of the State Series Editors: Achim Hurrelmann, Carleton University, Canada; Stephan Leibfried, University of Bremen,Germany; Kerstin Martens, University of Bremen, Germany; Peter Mayer, University of Bremen, Germany. Titles include: Joan DeBardeleben and Achim Hurrelmann (editors) DEMOCRATIC DILEMMAS OF MULTILEVEL GOVERNANCE Legitimacy, Representation and Accountability in the European Union Klaus Dingwerth THE NEW TRANSNATIONALISM Transnational Governance and Democratic Legitimacy Anna Holzscheiter CHILDREN’S RIGHTS IN INTERNATIONAL POLITICS The Transformative Power of Transnational Discourse Achim Hurrelmann, Steffen Schneider and Jens Steffek (editors) LEGITIMACY IN AN AGE OF GLOBAL POLITICS Achim Hurrelmann, Stephan Leibfried, Kerstin Martens and Peter Mayer (editors) TRANSFORMING THE GOLDEN-AGE NATION STATE Anja P. Jakobi INTERNATIONAL ORGANIZATIONS AND LIFELONG LEARNING From Global Agendas to Policy Diffusion Kerstin Martens, Alessandra Rusconi and Kathrin Leuze (editors) NEW ARENAS OF EDUCATION GOVERNANCE The Impact of International Organizations and Markets on Educational Policy Making Kerstin Martens, Alexander-Kenneth Nagel, Michael Windzio and Ansgar Weymann (editors) TRANSFORMATION OF EDUCATION POLICY Thomas Rixen THE POLITICAL ECONOMY OF INTERNATIONAL TAX GOVERNANCE Heinz Rothgang, Mirella Cacace, Lorraine Frisina, Simone Grimmeisen, Achim Schmid and Claus Wendt THE STATE AND HEALTHCARE Comparing OECD Countries Steffen Schneider, Achim Hurrelmann, Zuzana Krell-Laluhová, Frank Nullmeier and Achim Wiesner. DEMOCRACY’S DEEP ROOTS Why the Nation State Remains Legitimate Peter Starke RADICAL WELFARE STATE RETRENCHMENT A Comparative Analysis Jens Steffek, Claudia Kissling, Patrizia Nanz (editors) CIVIL SOCIETY PARTICIPATION IN EUROPEAN AND GLOBAL GOVERNANCE A Cure for the Democratic Deficit? Michael J. Warning TRANSNATIONAL PUBLIC GOVERNANCE Networks, Law and Legitimacy Hartmut Wessler, Bernhard Peters, Michael Brüggemann, Katharina Kleinen-von Königslöw, Stefanie Sifft TRANSNATIONALIZATION OF PUBLIC SPHERES Hartmut Wessler (editor) PUBLIC DELIBERATION AND PUBLIC CULTURE The Writings of Bernhard Peters, 1993–2005 Jochen Zimmerman, Jörg R. Werner, Philipp B. Volmer GLOBAL GOVERNANCE IN ACCOUNTING Public Power and Private Commitment Transformations of the State Series Standing Order ISBN 978–1–4039–8544–6 (hardback) 978–1–4039–8545–3 (paperback) You can receive future titles in this series as they are published by placing a standing order. Please contact your bookseller or, in case of difficulty, write to us at the address below with your name and address, the title of the series and one of the ISBNs quoted above. Customer Services Department, Macmillan Distribution Ltd, Houndmills, Basingstoke, Hampshire RG21 6XS, England. The State and Healthcare Comparing OECD Countries Heinz Rothgang Professor of Health Economics, Centre for Social Policy Research, University of Bremen Mirella Cacace Analyst, RAND Europe, United Kingdom Lorraine Frisina Research Fellow, University of Bremen, Germany Simone Grimmeisen Program Officer, Robert Bosch Stiftung GmbH, Germany Achim Schmid Research Fellow, University of Bremen, Germany and Claus Wendt Professor of Sociology for Health and Healthcare Systems, University of Siegen, Germany © Heinz Rothgang, Mirella Cacace, Lorraine Frisina, Simone Grimmeisen, Achim Schmid and Claus Wendt 2010 Softcover reprint of the hardcover 1st edition 2010 978-0-230-00548-8 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No portion of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, Saffron House, 6-10 Kirby Street, London EC1N 8TS. Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2010 by PALGRAVE MACMILLAN Palgrave Macmillan in the UK is an imprint of Macmillan Publishers Limited, registered in England, company number 785998, of Houndmills, Basingstoke, Hampshire RG21 6XS. Palgrave Macmillan in the US is a division of St Martin’s Press LLC, 175 Fifth Avenue, New York, NY 10010. Palgrave Macmillan is the global academic imprint of the above companies and has companies and representatives throughout the world. Palgrave® and Macmillan® are registered trademarks in the United States, the United Kingdom, Europe and other countries. ISBN 978-1-349-28214-2 ISBN 978-0-230-29234-5 (eBook) DOI 10.1057/9780230292345 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. Logging, pulping and manufacturing processes are expected to conform to the environmental regulations of the country of origin. A catalogue record for this book is available from the British Library. A catalogue record for this book is available from the Library of Congress. 10 9 8 7 6 5 4 3 2 1 19 18 17 16 15 14 13 12 11 10 Contents List of Illustrations vi List of Abbreviations ix Acknowledgements xiii Series Editors’ Preface xiv Notes on the Authors xvi Part I The Concept of the Study 1 Introduction to the Book 3 Heinz Rothgang 2 Conceptual Framework of the Study 10 Heinz Rothgang Part II Cross-Sectional Analyses 3 The Changing Role of the State in Healthcare Financing 25 Achim Schmid, Mirella Cacace and Heinz Rothgang 4 The Changing Role of the State in Healthcare Service Provision 53 Achim Schmid and Claus Wendt Part III Case Studies 5 The Role of the State in the British Healthcare System – Between Marketization and Statism 75 Simone Grimmeisen and Lorraine Frisina 6 The Self-Regulatory German Healthcare System Between Growing Competition and State Hierarchy 119 Heinz Rothgang, Achim Schmid and Claus Wendt 7 The US Healthcare System: Hierarchization With and Without the State 180 Mirella Cacace Part IV Conclusion 8 The Converging Role of the State in OECD Healthcare Systems 237 Heinz Rothgang References 248 Index 275 v Illustrations Tables 2.1 Types of regulation 14 2.2 State, societal, and private roles in a healthcare system 15 2.3 Healthcare system types 17 2.4 P otential transformative change in the structure of healthcare systems 20 3.1 Structure of the analysis 35 3.2 Coefficients of variation for different healthcare financing indicators 42 3.3 Similarity of the funding mix 46 4.1 The share of spending on inpatient care 61 4.2 T he public/private classification of service provision in healthcare sectors 63 4.3 The Public Service Provision Index (in per cent) 67 5.1 Emerging divergence patterns within the UK 110 6.1 Major healthcare reforms in Germany since 1970 124 6.2 Number of statutory sickness funds 136 6.3 Trichotomous Index of Service Provision (TIP) 143 6.4 Number of hospitals and hospital beds in private for-profit hospital chains 145 6.5 Healthcare coverage of German population in 2007 148 6.6 Changes in the regulation structure in Germany’s healthcare system 174 7.1 Overview of the major US healthcare reforms between 1965 and today 186 7.2 The public/private-mix in US service provision, trichotomous distinction 204 7.3 Market shares of health plans in employer-sponsored insurance (as percentages of workers with insurance coverage) 211 7.4 Health insurance coverage as percentages of total population 213 8.1 Changing role of the state in healthcare financing 239 8.2 Changing role of the state in service provision 241 8.3 The changing regulatory structures of Britain, Germany and the United States 242 8.4 C hanges in financing, service provision and regulation 245 vi Illustrations vii Figures 2.1 Conceptualization of a healthcare system 11 3.1 Mean health expenditure in per cent of GDP and the mean public financing share in 23 OECD countries 36 3.2 Sigma-convergence of total health expenditure 39 3.3 Convergence in public expenditure levels 40 3.4 Convergence in the structure of healthcare 41 3.5 Catch-up in public expenditure in per cent of GDP (1970–2006) 43 3.6 Catch-up in the public/private-mix (1970–2006) 44 3.7 Mean public healthcare financing share according to financing types 48 3.8 Coefficient of variation of the public spending share according to financing types 49 4.1 The size of healthcare sectors in 2004 59 5.1 Total health care expenditure as share of GDP and per capita 80 5.2 Public and private healthcare expenditure as share of GDP and per capita 81 5.3 Public and private healthcare financing as percentage of total healthcare financing 82 6.1 Total healthcare financing as a percentage of GDP and per capita 127 6.2 Public and private healthcare financing as a percentage of GDP and per capita 127 6.3 Public and private financing as a percentage of total health financing 128 6.4 Public and private financing of inpatient care/hospitals 131 6.5 Public and private financing of outpatient care 133 6.6 Public and private financing of pharmaceuticals/pharmacies 134 6.7 Hospital beds, health employment and physicians per 1,000 of population 138 6.8 Percentages of resource flows in all sectors 139 6.9 The inpatient care sector by ownership category 141 6.10 Coverage in percentage of total population 149 7.1 Total healthcare financing as a share of GDP and per capita 188 7.2 Public and private healthcare financing as a share of GDP and per capita 189 7.3 Public and private financing in percentages of total healthcare financing 190 7.4 Public health expenditures including and excluding federal tax exemptions (in per cent of total expenditure) 191 7.5 Public and private financing of inpatient care (Hospitals and nursing homes) 194 viii Illustrations 7.6 Public and private financing as percentages of outpatient care sectors 194 7.7 Public and private financing as percentages of pharmaceuticals and medical goods 195 7.8 Changes in service provision levels in percentages (Index year 2000=100 per cent) 200 7.9 Percentages of monetary resource flows in all sectors 201 7.10 Inpatient hospital beds according to ownership as percentages of total 202 Boxes 2.1 Objects of regulation 14 5.1 Excurse: The effects of devolution on the British healthcare system 108 Abbreviations AHA American Hospital Association AHIP America’s Health Insurance Plans AIG American International Group ALB Arm’s Length Bodies AMA American Medical Association AMG Pharmaceutical Act, Arzneimittelgesetz AMI American Medical International AOK Regional Funds, Allgemeine Ortskrankenkassen AUS Australia AUT Austria AVWG Arzneimittelversorgungs-Wirtschaftlichkeitsgesetz BBA Balanced Budget Act BCBS Blue Cross and Blue Shield health plans BEL Belgium BfArM Bundesinstitut für Arzneimittel und Medizinprodukte BKK Company-Based Funds, Betriebskrankenkassen BKn Miner’s Fund, Bundesknappschaft BUPA British United Provident Association CA Canada CDHP consumer-driven health plans CHAI Commission for Healthcare Audit and Inspection CH Switzerland CHI Commission for Health Improvement CHIP Children’s Health Insurance Program CHIPRA Children’s Health Insurance Program Reauthorization Act CMS Centers of Medicare and Medicaid Services COBRA Consolidated Omnibus Budget Reconciliation Act CON Certificate-of-Need DCIS Democratic Constitutional Interventionist States DDRB Doctors’ and Dentists’ Review Body df degrees of freedom DHHS Department of Health and Human Services DK Denmark DMP Disease Management Program DRG Diagnosis Related Group DSH disproportionate share hospitals EBM uniform valuation standard, einheitlicher Bewertungsmaßstab ECJ European Court of Justice EMTALA Emergency Medical Treatment and Active Labor Act ix
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