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La régulation économique des dépenses de santé : réflexions sur la réforme britannique

Author

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  • Dominique Bureau
  • Jacques Esposito

Abstract

[fre] Tout en offrant une couverture universelle, le N.H.S. est le système de santé qui enregistre une des meilleures performances dans le contrôle des dépenses de santé. Avant sa réforme, il représentait l'archétype du système public fiscalisé, dont la maîtrise des coûts n'était réalisée qu'au prix de contraintes réglementaires progressivement contestées. La réforme entreprise en 1991 y a rétabli certains mécanismes de marché, notamment une véritable fonction d'acheteur, les prestataires de soins de premier recours achetant des soins aux prestataires de second recours. Il s'agit là d'une réforme d'ensemble dont l'examen permet de dégager une grille d'analyse de portée générale sur la régulation des dépenses de santé. [eng] Despite universal coverage, the N.H.S. is the health system which obtains the best outcome for spending control. Prior to 1991, this result was associated with little consumer choice over health care, queues, and a general lack of flexibility. The 1991 reform has reintroduced market-type mechanisms in the N.H.S. One of its central ideas is the systematic identification of a purchaser function: the "GP fundholder", who is responsible for purchasing secondary services for his patients, is an agent of particular interest in this new context. The study of this wide-ranging reform provides an useful benchmark to discuss the various policy options available to improve the performances of health care systems.

Suggested Citation

  • Dominique Bureau & Jacques Esposito, 1996. "La régulation économique des dépenses de santé : réflexions sur la réforme britannique," Revue Française d'Économie, Programme National Persée, vol. 11(1), pages 147-181.
  • Handle: RePEc:prs:rfreco:rfeco_0769-0479_1996_num_11_1_999
    Note: DOI:10.3406/rfeco.1996.999
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