The effect of health care model on health systems' responses to economic crises

Motivation: The paper is concerned with relationships between model of health care and the responses of health systems to economic crises in OECD countries (1970–2013). The institutional arrangements are considered to affect the operation and performance of health systems in several ways; however, so far the topic has not been investigated in the economic crises context. Aim: This research attempts to bridge this gap by comparing the dynamics of health systems measures (male and female life expectancy; health expenditure; and doctors’ density) during years of recession with the average annual growth rate of the same measures for the countries clustered in four model groups. Results: The results show that the health care model applied is related with the systems’ responses to economic downturns. The Bismarck-type countries perform poorly in terms of health improvement and are incapable of containing costs during recessions. The Beveridge-type countries perform better in health improvement during stagnation; they also have effective cost-containment policies but they provide less security in terms of human resources for health than the Bismarck-type states. The market-oriented countries are in a superior position in health improvement when economies collapse; however, they fail to restrict health expenditure increase and to sustain the dynamics of doctors’ availability. The systems in transitions are characterized by a relatively low performance in female health improvement during recessions, a moderate situation in securing access to physicians and the greatest possibilities of containing costs. For the policymakers, the results imply that there is no universally superior model of health care organization.