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Health policy in times of austerity—A conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008

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  • Wenzl, Martin
  • Naci, Huseyin
  • Mossialos, Elias

Abstract

The objective of this paper is to provide a framework for evaluation of changes in health policy against overarching health system goals. We propose a categorisation of policies into seven distinct health system domains. We then develop existing analytical concepts of insurance coverage and cost-effectiveness further to evaluate the effects of policies in each domain on equity and efficiency. The framework is illustrated with likely effects of policy changes implemented in a sample of European countries since 2008. Our illustrative analysis suggests that cost containment has been the main focus and that countries have implemented a mix of measures that are efficient or efficiency neutral. Similarly, policies are likely to have mixed effects on equity. Additional user charges were a common theme but these were frequently accompanied by additional exemptions, making their likely effects on equity difficult to evaluate. We provide a framework for future, and more detailed, evaluations of changes in health policy.

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  • Wenzl, Martin & Naci, Huseyin & Mossialos, Elias, 2017. "Health policy in times of austerity—A conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008," Health Policy, Elsevier, vol. 121(9), pages 947-954.
    • Handle: RePEc:eee:hepoli:v:121:y:2017:i:9:p:947-954
    DOI: 10.1016/j.healthpol.2017.07.005
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    References listed on IDEAS

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    1. García-Armesto, Sandra & Campillo-Artero, Carlos & Bernal-Delgado, Enrique, 2013. "Disinvestment in the age of cost-cutting sound and fury. Tools for the Spanish National Health System," Health Policy, Elsevier, vol. 110(2), pages 180-185.
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    7. Cervero-Liceras, Francisco & McKee, Martin & Legido-Quigley, Helena, 2015. "The effects of the financial crisis and austerity measures on the Spanish health care system: A qualitative analysis of health professionals’ perceptions in the region of Valencia," Health Policy, Elsevier, vol. 119(1), pages 100-106.
    8. Gené-Badia, Joan & Gallo, Pedro & Hernández-Quevedo, Cristina & García-Armesto, Sandra, 2012. "Spanish health care cuts: Penny wise and pound foolish?," Health Policy, Elsevier, vol. 106(1), pages 23-28.
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    Cited by:

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    2. Helen M. Lloyd & Inger Ekman & Heather L. Rogers & Vítor Raposo & Paulo Melo & Valentina D. Marinkovic & Sandra C. Buttigieg & Einav Srulovici & Roman Andrzej Lewandowski & Nicky Britten, 2020. "Supporting Innovative Person-Centred Care in Financially Constrained Environments: The WE CARE Exploratory Health Laboratory Evaluation Strategy," IJERPH, MDPI, vol. 17(9), pages 1-19, April.
    3. Ponzo, Michela & Scoppa, Vincenzo, 2021. "Does demand for health services depend on cost-sharing? Evidence from Italy," Economic Modelling, Elsevier, vol. 103(C).
    4. Edney, L.C. & Haji Ali Afzali, H. & Cheng, T.C. & Karnon, J., 2018. "Mortality reductions from marginal increases in public spending on health," Health Policy, Elsevier, vol. 122(8), pages 892-899.
    5. García-Cornejo, Beatriz & Pérez-Méndez, José A., 2018. "Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level," Health Policy, Elsevier, vol. 122(4), pages 396-403.
    6. Guccio, C.; & Pignataro, G.; & Romeo, D.; & Vidoli, F.;, 2022. "Is austerity good for efficiency, at least? A counterfactual assessment for the Italian NHS," Health, Econometrics and Data Group (HEDG) Working Papers 22/28, HEDG, c/o Department of Economics, University of York.

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