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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 ...

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Paper provided by OECD Publishing in its series OECD Economics Department Working Papers with number 374.

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Date of creation: 05 Dec 2003
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Handle: RePEc:oec:ecoaaa:374-en
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