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

Author

Listed:
  • 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)

Abstract

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.

Suggested Citation

  • Zeynep Or & Chantal Cases & Melanie Lisac & Karsten Vrangbaek & Ulrika Winblad & Gwyn Bevan, 2009. "Are Health Problems Systemic? Politics of Access and Choice under Beveridge and Bismarck Systems," Working Papers DT27, IRDES institut for research and information in health economics, revised Sep 2009.
  • Handle: RePEc:irh:wpaper:dt27
    as

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    References listed on IDEAS

    as
    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 & 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.
    3. P.C. Smith, 2002. "Measuring health system performance," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 3(3), pages 145-148, September.
    4. Carine Franc & Marc Perronnin & Aurélie Pierre, 2008. "Private Supplementary Health Insurance: Retirees' Demand," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 33(4), pages 610-626, October.
    5. Florence Jusot & Michel Grignon & Paul Dourgnon, 2007. "Psychosocial resources and social health inequalities in France: Exploratory findings from a general population survey," Working Papers DT6, IRDES institut for research and information in health economics, revised Nov 2007.
    6. 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.
    7. 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.
    8. 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.
    9. Zeynep Or & Florence Jusot & Engin Yilmaz, 2008. "Impact of health care system on socioeconomic inequalities in doctor use," Working Papers DT17, IRDES institut for research and information in health economics, revised Sep 2008.
    10. repec:dau:papers:123456789/7004 is not listed on IDEAS
    11. 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.
    12. 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.
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    Cited by:

    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. Groenewegen, Peter P. & Dourgnon, Paul & Greß, Stefan & Jurgutis, Arnoldas & Willems, Sara, 2013. "Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries," Health Policy, Elsevier, vol. 113(1), pages 170-179.
    3. Thierry Debrand & Christine Sorasith, 2010. "Bouclier sanitaire : choisir entre égalité et équité ? Une analyse à partir du modèle ARAMMIS," Working Papers DT32, IRDES institut for research and information in health economics, revised Jun 2010.
    4. repec:taf:pubmmg:v:36:y:2016:i:6:p:409-416 is not listed on IDEAS
    5. André, Christine, 2015. "Les systèmes de santé européens en longue période," Revue de la Régulation - Capitalisme, institutions, pouvoirs, Association Recherche et Régulation, vol. 17.
    6. Catherine Pollak, 2012. "Employed and Happy despite Weak Health? Labour Market Participation and Job Quality of Older Workers with Disabilities," Working Papers DT45, IRDES institut for research and information in health economics, revised Mar 2012.
    7. Sergey Shishkin & Alexandra Burdyak & Elena Potapchik, 2013. "Patient choice in the post-Semashko health care system," HSE Working papers WP BRP 09/PA/2013, National Research University Higher School of Economics.
    8. Göpffarth, Dirk & Henke, Klaus-Dirk, 2013. "The German Central Health Fund—Recent developments in health care financing in Germany," Health Policy, Elsevier, vol. 109(3), pages 246-252.
    9. Ongaro, Edoardo & Ferré, Francesca & Fattore, Giovanni, 2015. "The fiscal crisis in the health sector: Patterns of cutback management across Europe," Health Policy, Elsevier, vol. 119(7), pages 954-963.
    10. Helene Barroy & Zeynep Or & Ankit Kumar & David Bernstein, 2014. "Sustaining Universal Health Coverage in France: A Perpetual Challenge," Health, Nutrition and Population (HNP) Discussion Paper Series 91323, The World Bank.
    11. Joan Costa-Font & Valentina Zigante, 2016. "The choice agenda in European health systems: the role of middle-class demands," Public Money & Management, Taylor & Francis Journals, vol. 36(6), pages 409-416, September.
    12. Christine André & Philippe Batifoulier & Mariana Jansen-Ferreira, 2016. "Privatisation de la santé en Europe. Un outil de classification des réformes," CEPN Working Papers hal-01256505, HAL.
    13. Zigante, Valentina, 2011. "Assessing welfare effects of the European Choice Agenda: the case of health care in the United Kingdom," LSE Research Online Documents on Economics 53449, London School of Economics and Political Science, LSE Library.
    14. Tenbensel, Tim & Eagle, Samantha & Ashton, Toni, 2012. "Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity," Health Policy, Elsevier, vol. 106(1), pages 29-36.
    15. Nicolas Sirven & Brigitte Santos-Eggimann & Jacques Spagnoli, 2012. "Comparability of Health Care Responsiveness in Europe," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 105(2), pages 255-271, January.
    16. Christine André & Philippe Batifoulier & Mariana Jansen-Ferreira, 2016. "Privatisation de la santé en Europe. Un outil de classification des réformes," Working Papers hal-01256505, HAL.

    More about this item

    Keywords

    Health system; Beveridge; Bismarck; reforms; performance;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O57 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Comparative Studies of Countries

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