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Are Health Problems Systemic? Politics of Access and Choice under Beveridge and Bismarck Systems

  • Zeynep Or

    ()

    (IRDES institut for research and information in health economics)

  • Chantal Cases

    ()

    (IRDES institut for research and information in health economics)

  • Melanie Lisac

    ()

    (Bertelsmann Stiftung)

  • Karsten Vrangbaek

    ()

    (University of Copenhagen)

  • Ulrika Winblad

    ()

    (Department of Public Health and Caring Sciences Uppsala Univeristy)

  • Gwyn Bevan

    ()

    (London School of Economics)

Industrialised countries face similar challenges for improving the performance of their health system. Nevertheless the nature and intensity of the reforms required are largely determined by each country's basic social security model. This paper looks at the main differences in performance of five countries and reviews their recent reform experience, focusing on three questions: Are there systematic differences in performance of Beveridge and Bismarck-type systems? What are the key parameters of health care system which underlie these differences? Have recent reforms been effective? Our results do not suggest that one system-type performs consistently better than the other. In part, this may be explained by the heterogeneity in organisational design and governance both within and across these systems. Insufficient attention to those structural differences may explain the limited success of a number of recent reforms.

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File URL: http://www.irdes.fr/EspaceAnglais/Publications/WorkingPapers/DT27AreHealthProblemsSysmetic.pdf
File Function: First version, 2009
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Paper provided by IRDES institut for research and information in health economics in its series Working Papers with number DT27.

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Length: 29 pages
Date of creation: Sep 2009
Date of revision: Sep 2009
Handle: RePEc:irh:wpaper:dt27
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  1. Or, Zeynep & Cases, Chantal & Lisac, Melanie & Vrangbæk, Karsten & Winblad, Ulrika & Bevan, Gwyn, 2010. "Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems," Health Economics, Policy and Law, Cambridge University Press, vol. 5(03), pages 269-293, July.
  2. Dourgnon, Paul & Grignon, Michel & Jusot, Florence, 2007. "Psychosocial resources and social health inequalities in France : Exploratory findings from a general population survey," Economics Papers from University Paris Dauphine 123456789/7007, Paris Dauphine University.
  3. Dourgnon, Paul & Naiditch, Michel, 2010. "The preferred doctor scheme: A political reading of a French experiment of Gate-keeping," Health Policy, Elsevier, vol. 94(2), pages 129-134, February.
  4. Jusot, Florence & Sermet, Catherine & Devaux, Marion & Tubeuf, Sandy, 2008. "Social heterogeneity in self-reported health status and measurement of inequalities in health," Economics Papers from University Paris Dauphine 123456789/7004, Paris Dauphine University.
  5. Carine Franc & Marc Perronnin & Aurelie Pierre, 2008. "Private supplemental health insurance: retirees' demand," Working Papers DT9, IRDES institut for research and information in health economics, revised Apr 2008.
  6. P.C. Smith, 2002. "Measuring health system performance," The European Journal of Health Economics, Springer, vol. 3(3), pages 145-148, September.
  7. Didier Blanchet & Thierry Debrand, 2008. "The sooner, the better? Analyzing preferences for early retirement in European countries," Working Papers DT13, IRDES institut for research and information in health economics, revised Jul 2008.
  8. Yilmaz, Engin & Jusot, Florence & Or, Zeynep, 2008. "Impact of health care system on socioeconomic inequalities in doctor use," Economics Papers from University Paris Dauphine 123456789/7006, Paris Dauphine University.
  9. Thierry Debrand & Aurélie Pierre & Caroline Allonier & Veronique Lucas-Gabrielli, 2008. "Health status, Neighbourhood effects and Public choice: Evidence from France," Working Papers DT11, IRDES institut for research and information in health economics, revised Jun 2008.
  10. Michel Grignon & Bidénam Kambia-Chopin, 2009. "Income and the Demand for Complementary Health Insurance in France," Working Papers DT24, IRDES institut for research and information in health economics, revised Apr 2009.
  11. Nicolas Sirven & Brigitte Santos-Eggimann & Jacques Spagnoli, 2008. "Comparability of Health Care Responsiveness in Europe using anchoring vignettes from SHARE," Working Papers DT15, IRDES institut for research and information in health economics, revised Sep 2008.
  12. Thierry Debrand & Pascale Lengagne, 2008. "Working Conditions and Health of European Older Workers," Working Papers DT8, IRDES institut for research and information in health economics, revised Feb 2008.
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