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Trends in EU Health Care Systems PDF

522 Pages·2007·2.377 MB·English
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Trends in EU Health Care Systems Trends in EU Health Care Systems Win de Gooijer Win de Gooijer Silodam 250 1013 AS Amsterdam The Netherlands [email protected] Library of Congress Control Number:2006930266 ISBN-10:0-387-32747-9 e-ISBN-10:0-387-32748-7 ISBN-13:978-0-387-32747-1 e-ISBN-13:978-0-387-32748-8 Printed on acid-free paper. © 2007 Springer Science+Business Media,LLC All rights reserved.This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media,LLC,233 Spring Street, New York,NY 10013,USA),except for brief excerpts in connection with reviews or scholarly analysis.Use in connection with any form of information storage and retrieval,electronic adap- tation,computer software,or by similar or dissimilar methodology now known or hereafter developed is forbidden.The use in this publication of trade names,trademarks,service marks, and similar terms,even if they are not identified as such,is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. 9 8 7 6 5 4 3 2 1 springer.com for Aaltje Contents Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii Part One: A Changing Social Context Chapter 1. Moving Along a Continuum . . . . . . . . . . . . . . . . . . . . 3 Chapter 2. Promoting and Opposing the Market . . . . . . . . . . . . . 41 Chapter 3. The Arguments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Chapter 4. The Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Part Two: Consequences for Health Care Systems Chapter 5. Health Care and the Economic Order . . . . . . . . . . . . 91 Chapter 6. Health Care Dynamics . . . . . . . . . . . . . . . . . . . . . . . . . 118 Chapter 7. The Influence of the European Union . . . . . . . . . . . . . 139 Chapter 8. Investing in Health Care . . . . . . . . . . . . . . . . . . . . . . . 160 Chapter 9. Health Care Reforms . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Chapter 10. The Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226 vii viii Contents Part Three: Reflections Chapter 11. The Social Context Reconsidered . . . . . . . . . . . . . . . . 257 Chapter 12. On Managing Health Care . . . . . . . . . . . . . . . . . . . . . 288 Epilogue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304 Notes and References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 485 Foreword Since the beginning of the 1980s,governments all over the developed world have been engaged in reforming their health care systems and in trying to find ways of coping with the problem of continuously rising costs.Methods aimed at improving the effectiveness and efficiency of health care delivery, shifting the financial burden from public to private financing, as well as reducing the health care infrastructure, are being studied and developed. During the many years that I served on the Board of the Federation of Dutch Health Care Organizations, including as Chairman from 1992 to 1999, I experienced directly the consequences of limiting the financial resources available to health care.It became apparent to me during those years that the social climate regarding health care in the Netherlands was changing.That changing climate can be encapsulated by the word account- ability.Accountability has come to mean that health care is the business of a range of stakeholders,all of whom want developments to go their way.In short,health care now has multiple owners. Later,after I had joined the Governing Council of the International Hos- pital Federation, I found that similar developments could be observed throughout the developed world.These developments are characterized by the decreasing involvement of governments in the financing and delivery of health care.Instead,the market,and with it the price of health care,is increasingly becoming the instrument for coordinating of supply and demand. The reform of health care systems in most of the countries of the European Union is conditional on providing equal access for all citizens, regardless of their ability to pay.National constitutions,or their equivalents, mandate governments’ responsibility in this respect. As a consequence, exemption regulations aimed at protecting vulnerable members of society have been introduced by EU governments which have carried through cost- saving measures. These regulations are meant to uphold the idea of solidarity in health care. Whether or not EU governments, by applying exemption regulations, have succeeded in living up to their promise of equal access is,in fact,the ix x Foreword theme of this book.In order to deal with it,the author has chosen an orig- inal approach,by considering health care in the context of the recent devel- opments in the international political economy.Since 1975,that context has been characterized by governments of the developed world withdrawing from the economic process and leaving the production and consumption of goods and services increasingly to the market.As a consequence,inequali- ties in health care—as in society as a whole—are increasing.The author concludes that,despite the application of exemption regulations,increasing inequalities put the solidarity principle,a mainstay of most EU health care systems,at risk. The arguments for governments to withdraw from the economic process are twofold.Firstly,it is argued that the phenomenon of globalization forces governments of the developed world to reduce the costs of labor in order for businesses to stay competitive.Secondly,it is argued that a free market economy with the price mechanism as the instrument for coordination, instead of a government interfering in the economic process,better serves to satisfy the needs of individual consumers.As a member of the Dutch Social Economic Council in the 1990s, I was aware that these arguments were applied to many spheres of economic activity.I concluded that these two arguments are far less suitable for application to health care if the prin- ciple of equal access is to be realized.Furthermore,according to the author of this book, both arguments are controversial. Societies appear to have more freedom to choose their social arrangements than the international political economy wants us to believe. After having read the manuscript,I unreservedly recommend the book to politicians, health care policy-makers, insurers, managers, and all those who take equity in health care to heart. Ton Krol Former President of the International Hospital Federation Acknowledgments I have worked at the CEO management level in health care in the Nether- lands for more than 25 years. During those years, I experienced times of plenty,when the sky was the limit,as well as times of want,when I had to think of measures to increase the efficiency and effectiveness of daily oper- ations.Working in health care was an enriching challenge for me,the more so since I also had the honor to serve on several national governing boards. That taught me how closely health care policy is connected to the economy and to politics. Furthermore,I had the privilege of representing the Federation of Dutch Health Care Organizations in the European Hospital and Health Care Fed- eration (HOPE) for more than 20 years.Because this federation appointed me to the office of President of its Subcommittee on Economics and Plan- ning,I had the opportunity to learn about health care developments in the other countries of the European Union. During the years when I worked in and for health care,I had the plea- sure to meet with experts from the Netherlands and abroad.Many of them have become friends.Knowing that I was working on this book,they not only brought me important information, but they were also prepared to discuss my ideas and to comment on draft versions of the book.Now that the book is finished,it’s time to express my gratitude for their kindness. First of all I want to thank several members of the European Hospital and Health Care Federation to whom I am particularly grateful.They are Kris Schutyser (Belgium), former Secretary-General of HOPE; Brian Edwards (United Kingdom), the president of HOPE, who regularly informed me about publications that could be useful for the manuscript,as did his predecessors Gérard Vincent (France) and Denis Doherty (Ireland). The latter also commented on earlier draft versions of the manuscript.As for other (observer) members of HOPE,it is with pleasure that I thank the Secretary-General, Pascal Garel (France); my successor as President of the Subcommittee on Economics and Planning,Carine Boonen (Belgium); as well as Ursula Fronaschütz (Austria), Anetta Dokova (Bulgaria), György Harmat (Hungary), Willy Heuschen (Belgium), Lars Johansson xi

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