IDEAS home Printed from
   My bibliography  Save this paper

Health-Care Systems: Lessons from the Reform Experience


  • Elizabeth Docteur
  • Howard Oxley


This study reviews health-system reforms in OECD countries over the past several decades and their impact on the following policy goals: ensuring access to services; improving the quality of care and its outcomes; allocating an “appropriate” level of resources to health care (macroeconomic efficiency); and ensuring microeconomic efficiency in service provision. While nearly all OECD countries have achieved universal insurance coverage, initiatives to address persistent disparities in access are now being undertaken in a number of countries. In light of new evidence of serious problems with health-care quality, many countries have recently introduced reforms, but it is too soon to generalise as to the relative effects of alternative approaches. Instruments aimed at cost control have succeeded in slowing the growth of (particularly public) health-care spending over the 1980s and 1990s but health-care spending continues to rise as a share of GDP in most countries. A few countries have ...This paper is also published under OECD Health Working Papers Series. Cette étude présente les réformes des systèmes de santé des pays de l’OCDE qui se sont opérées au cours des dernières décennies et leur impact sur les objectifs de politique économique suivants: assurer l’accès aux services de santé; améliorer la qualité des soins; allouer un niveau « approprié » de ressources à la santé (efficience macroéconomique) ; et s’assurer que les services soient dispensés de façon à optimiser l’efficience microéconomique. Alors que presque tous les pays de l’OCDE ont mis en place une couverture universelle, les initiatives se multiplient pour résoudre les problèmes de disparités résiduelles d’accès aux soins. Un grand nombre de pays ont introduit des réformes pour tenter de corriger de sérieux problèmes de qualité mais il est encore trop tôt évaluer leurs effets. Les mesures visant à contrôler les coûts ont réussi à réduire la croissance des dépenses de santé au cours des années 80 et 90, mais les dépenses de santé exprimées en pourcentage du GDP ...

Suggested Citation

  • Elizabeth Docteur & Howard Oxley, 2003. "Health-Care Systems: Lessons from the Reform Experience," OECD Economics Department Working Papers 374, OECD Publishing.
  • Handle: RePEc:oec:ecoaaa:374-en

    Download full text from publisher

    File URL:
    Download Restriction: no

    Other versions of this item:

    More about this item


    health care reforms; health care systems; réforme des systèmes de santé; système de santé;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

    NEP fields

    This paper has been announced in the following NEP Reports:


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:oec:ecoaaa:374-en. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.