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Health Care Systems: Efficiency and Institutions


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  • Isabelle Joumard
  • Christophe André
  • Chantal Nicq


This paper presents a set of indicators to assess health care system performance. It also presents new comparative data on health care policies and institutions for OECD countries. This set of indicators allows the empirical characterisation of health care systems and the identification of groups of countries sharing similar health institutions. It also helps to uncover strengths and weaknesses of each country’s health care system and assessing the scope for improving value-for-money. The empirical analysis suggests that there is room in all countries surveyed to improve the effectiveness of health care spending; there is no health care system that performs systematically better in delivering cost-effective health care – big-bang reforms are therefore not warranted; increasing the coherence of policy settings, by adopting best policy practices within a similar system and borrowing the most appropriate elements from other systems will likely be more practical and effective to raise health care spending efficiency. Systèmes de santé : efficacité et institutions Ce document présente un ensemble d’indicateurs afin d’évaluer la performance des systèmes de santé. Il présente aussi de nouvelles données comparatives sur les politiques et les institutions dans le domaine de la santé pour les différents pays de l’OCDE. Cet ensemble d’indicateurs permet de caractériser empiriquement les systèmes de santé en identifiant des groupes de pays ayant des politiques et institutions comparables. Il permet aussi de mettre en valeur les forces et les faiblesses du système de santé de chaque pays et de déterminer les gains potentiels d’efficacité. L’analyse empirique montre que dans chacun des pays étudiés l’efficacité des dépenses de santé peut être améliorée; qu’il n’existe pas de système qui, pour un coût donné, produit systématiquement des meilleurs résultats – des réformes radicales en faveur d’un système de santé ne sont donc pas nécessaires ; accroitre la cohérence des politiques en matière de santé en adoptant les politiques les plus performantes à l’intérieur d’un système similaire et en empruntant les éléments les plus appropriés aux autres systèmes s’avérera vraisemblablement plus réaliste et plus efficace pour améliorer l’efficacité de la dépense en matière de santé.

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Bibliographic Info

Paper provided by OECD Publishing in its series OECD Economics Department Working Papers with number 769.

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Date of creation: 19 May 2010
Date of revision:
Handle: RePEc:oec:ecoaaa:769-en

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Keywords: public spending; efficiency; health institutions and policies; health care system; dépenses publiques; institutions et politiques de santé; système de santé; efficacité;

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Cited by:
  1. Shuyun May Li, Solmaz Moslehi, Siew Ling Yew, 2012. "Public-Private Mix of Health Expenditure: A Political Economy Approach and A Quantitative Exercise," Department of Economics - Working Papers Series, The University of Melbourne 1157, The University of Melbourne.
  2. Jabłonowski, Janusz & Müller, Christoph, 2014. "A fiscal outlook for Poland: Update 2014. Background paper prepared for the World Bank's Country Economic Memorandum (CEM) for Poland," FZG Discussion Papers 54, Research Center for Generational Contracts (FZG), University of Freiburg.
  3. Balázs Égert, 2011. "Bringing French Public Debt Down: The Options for Fiscal Consolidation," OECD Economics Department Working Papers 858, OECD Publishing.
  4. Rauf Gönenç & Maria M. Hofmarcher & Andreas Wörgötter, 2011. "Reforming Austria's Highly Regarded but Costly Health System," OECD Economics Department Working Papers 895, OECD Publishing.
  5. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2012. "Classifying OECD healthcare systems: A deductive approach," TranState Working Papers 165, University of Bremen, Collaborative Research Center 597: Transformations of the State.
  6. Caroline Klein & Robert W.R. Price & Andreas Wörgötter, 2013. "Improving the Fiscal Framework to Enhance Growth in an Era of Fiscal Consolidation in Slovakia," OECD Economics Department Working Papers 1018, OECD Publishing.
  7. Stéphanie Jamet & Thomas Chalaux & Vincent Koen, 2013. "Labour Market and Social Policies to Foster More Inclusive Growth in Sweden," OECD Economics Department Working Papers 1023, OECD Publishing.
  8. Łukasz Rawdanowicz & Eckhard Wurzel & Ane Kathrine Christensen, 2013. "The Equity Implications of Fiscal Consolidation," OECD Economics Department Working Papers 1013, OECD Publishing.
  9. Rossana Merola & Douglas Sutherland, 2012. "Fiscal Consolidation: Part 3. Long-Run Projections and Fiscal Gap Calculations," OECD Economics Department Working Papers 934, OECD Publishing.
  10. Francesco Grigoli, 2012. "Public Expenditure in the Slovak Republic," IMF Working Papers 12/173, International Monetary Fund.
  11. Åsa Johansson & Yvan Guillemette & Fabrice Murtin & David Turner & Giuseppe Nicoletti & Christine de la Maisonneuve & Philip Bagnoli & Guillaume Bousquet & Francesca Spinelli, 2013. "Long-Term Growth Scenarios," OECD Economics Department Working Papers 1000, OECD Publishing.
  12. Francesco Grigoli & Eduardo Ley, 2012. "Quality of Government and Living Standards," World Bank Other Operational Studies 17093, The World Bank.
  13. Galina Besstremyannaya & Jaak Simm, 2012. "The impact of private health insurers on the quality of Russian regional health systems," Working Papers w0177, Center for Economic and Financial Research (CEFIR).
  14. Márta Somogyvári, 2013. "The Costs of Organisational Injustice in the Hungarian Health Care System," Journal of Business Ethics, Springer, Springer, vol. 118(3), pages 543-560, December.
  15. Sutherland, Douglas, 2012. "Fiscal Consolidation Needs and Implications for Growth," MPRA Paper 38745, University Library of Munich, Germany.
  16. Merola, Rossana & Sutherland, Douglas, 2014. "Fiscal Consolidation and Implications of Social Spending for Long-Term Fiscal Sustainability," Papers, Economic and Social Research Institute (ESRI) RB2014/1/2, Economic and Social Research Institute (ESRI).
  17. Böhm, Katharina & Schmid, Achim & Götze, Ralf & Landwehr, Claudia & Rothgang, Heinz, 2013. "Five types of OECD healthcare systems: Empirical results of a deductive classification," Health Policy, Elsevier, Elsevier, vol. 113(3), pages 258-269.


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