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Concurrence entre assureurs, entre prestataires et monopole naturel

  • Agnès Bocognano
  • Agnès Couffinhal
  • Michel Grignon
  • Ronan Mahieu
  • Dominique Polton

[spa] Competencia entre aseguradores, prestatarios y monopolio natural Una resena de las experiencias extranjeras en sanidad. El estudio de los sistemas de sanidad de aquellos pafses : que han favorecido la competencia en la funciôn de seguro-enfermedad (Singapur, Chile, e incluso Estados Unidos) sugiere que tal enfoque alberga un fuerte riesgo de iniquidad. En cambio, las experiencias de managed care en los Estados Unidos y de fundholding en el Reino : Unido muestran que es posible racionalizar la oferta de : cuidados sin que necesariamente se degrade la calidad de las prestaciones. Sera posible mejorar la eficacia del proceso de producciôn de los cuidados mediante la introducciôn de unos mecanismos competitivos, sin-, renunciar a una financiaciôn socializada de los gastos ? Alemania y los Pafses Bajos tratan en la actualidad de seguir esta via. Aquellas experiencias que parecen mâs eficaces, descansan en un regulador de multiples prerrogativas : este debe garantizar la calidad de las prestaciones mediante la elaboraciôn de unos criterios estandarizados t y velar por que las ganancias realizadas por los agentes en competencia, aseguradores y agrupaciones médicas, sean el fruto de una racionalizaciôn del proceso; productivo y no de unos fenômenos de autoselecciôn de los pacientes segûn el nivel de riesgo. El evitar este; obstâculo requière una profunda reflexion en cuanto al nivel de la cobertura que pueden y deben garantizar los agentes, y al modo de remuneraciôn de los agentes en ; competencia. En el caso de las experiencias americana y britânica, involucrara los médicos en la gestion del riesgo , ha sido eficaz, aunque dicha gestion supone unas habilidades suplementarias, entre otras en materia de tratamiento de la information. [eng] Competition among Insurers and Service Providers and Natural Monopolies An International Review of Health Measures. The study of different countries, health systems talks a great deal about health insurance competition (Singapore, Chile and even the United States). Such competition could harbour a substantial risk of inequity. However, American managed care and British fundholding both show that the health supply can be rationalised without necessarily, undermining 'service quality. Can competitive mechanisms make health care more efficient without losing social security funding? Germany and the Netherlands are currently trying this out: The apparently most efficient measures are based on a multi-skills regulator. This regulator guarantees service quality by introducing standardised criteria and checking that the profits made by the competing health insurers and groups come from rationalising the productive process rather than the self-selection of patients by their level of risk. Avoiding this pitfall requires in-depth thinking on the level of cover that agents can or should guarantee and how to remunerate competing agents. The Americans and British have found it efficient to get doctors highly involved in risk management, even though this demands additional skills, especially in data processing. [ger] Wettbewerb zwischen versicherern, zwischen leistungserbringern und natûrlichem monopol Ein Ûberblick uber die auslàndischen Erfahrungen im Gesundheitswesen Die Untersuchung der Gesundheitssysteme der Lànder, in denen dem Wettbewerb bei der Krankenversicherung

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File URL: http://dx.doi.org/doi:10.3406/estat.1999.6342
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File URL: http://www.persee.fr/doc/estat_0336-1454_1999_num_328_1_6342
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Article provided by Programme National Persée in its journal Economie et statistique.

Volume (Year): 328 (1999)
Issue (Month): 1 ()
Pages: 21-36

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Handle: RePEc:prs:ecstat:estat_0336-1454_1999_num_328_1_6342
Note: DOI:10.3406/estat.1999.6342
Contact details of provider: Web page: http://www.persee.fr/collection/estat

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