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Abstract

The reforms in health care which have been carried out during the past decades were meant to contribute to quality improvement and cost con- tainment, while maintaining the equity principle. And, indeed, medical prac- tice based on guidelines, protocols, or evidence-based medicine can increase the streamlining and predictability of professionals’ performance. Decen- tralization of a health care system can lead to more involvement of local stakeholders in the development of health policy. Prospective budgeting has forced hospital managers to analyze the health care delivery process from the perspectives of efficiency and effectiveness. So has the rise of the inter- nal market. Empowering patients has contributed to the maturation of the relation between health care providers and consumers, whereas health tech- nology assessment has mitigated the “easy market” image of health care. Finally, cost containment measures regarding pharmaceuticals and the introduction of cost-sharing methods may have made consumers more aware that health care has its price.

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References

Chapter 10

  1. Crainich, D. and Closon, M.-C.: Cost Containment and Health Care Reform in Belgium, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 219.

    Google Scholar 

  2. Christiansen, T., Enemark, U., Clausen, J., and Poulsen, P.: Health Care and Cost Containment in Denmark, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 289.

    Google Scholar 

  3. Hughes, J.: ibid., p. 487.

    Google Scholar 

  4. De Volkskrant, 16 September 2005.

    Google Scholar 

  5. Le Fanu: ibid., p. xviii.

    Google Scholar 

  6. In this respect, Louckx correctly observes that this is a simplistic view of moral hazard. To him, moral hazard involves a complex interaction of different factors. It is not correct to assume that patients necessarily consume more health care if cost-sharing is left out, and neither does cost-sharing automatically result in a lesser use of health services (Louckx, F.: Patient Cost-Sharing and Access to Care, in: Mackenbach, J. and Bakker, M., (eds.): Reducing Inequalities in Health: A European Perspective, Routledge, 2002, pp. 191–192).

    Google Scholar 

  7. Mossialos, E. and Le Grand, J.: ibid., p. 63.

    Google Scholar 

  8. Mossialos, E. and Le Grand: ibid., pp. 82–83.

    Google Scholar 

  9. Mossialos, E. and Le Grand, J., (eds.): ibid., p. 454.

    Google Scholar 

  10. Donatini, A., Rico, A., D’Ambrosio, M. M., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., pp. 46–47.

    Google Scholar 

  11. European Observatory on Health Care Systems: Health Care Systems in Transition: Spain, 2000, ibid., p. 114.

    Google Scholar 

  12. Coulter, A. and Magee, H.: ibid., p. 120.

    Google Scholar 

  13. Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 30.

    Google Scholar 

  14. Mossialos, E. and Le Grand: ibid., p. 83.

    Google Scholar 

  15. Hughes, J.: ibid., p. 500.

    Google Scholar 

  16. Robinson, R.: User Charges for Health Care, in: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J., (eds.): ibid., p. 181.

    Google Scholar 

  17. OECD: The Reform of Health Care Systems: A Review of Seventeen OECD Countries, ibid., p. 261.

    Google Scholar 

  18. Exter, A. den, Hermans, H., Dosljak, M., and Busse, R.: ibid., p. 48.

    Google Scholar 

  19. Busse, R. and Howorth, Ch.: Cost Containment in Germany, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 324.

    Google Scholar 

  20. Lancry, P.-J. and Sandier, S.: Twenty Years of Cures for the French Health Care System, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 449.

    Google Scholar 

  21. Saltman, R. B. and Figueras, J.: ibid., p. 100.

    Google Scholar 

  22. Sandier, S., Paris, V., and Polton, D.: ibid., pp. 40–41.

    Google Scholar 

  23. European Observatory on Health Care Systems: Health Care Systems in Transition: Germany, 2000, ibid., pp. 48–49.

    Google Scholar 

  24. Sissouras, A., Karokis, A., and Mossialos, E.: Health Care and Cost Containment in Greece, in: Mossialos, E. and Le Grand, J. (eds.): ibid., p. 379.

    Google Scholar 

  25. Pereira, J., Campos, A. C. de, Ramos, F., Simões, J., and Reis, V.: Health Care Reform and Cost Containment in Portugal, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 655.

    Google Scholar 

  26. Theurl, E.: ibid., pp. 623–624.

    Google Scholar 

  27. Mossialos, E. and Dixon, A.: Funding Health Care:An Introduction in: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J., (eds.): ibid., p. 23.

    Google Scholar 

  28. Fattore, G.: Cost Containment and Reforms in the Italian National Health Service, in: Mossialos, E. and Le Grand, J., (eds.), ibid., p. 522.

    Google Scholar 

  29. Fattore, G.: Cost Containment and Health Care Reforms in the British NHS, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 740.

    Google Scholar 

  30. Robinson, R.: User Charges for Health Care, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 178.

    Google Scholar 

  31. In this respect, it should be taken into account that the much-quoted Rand Corporation research, showing consumers’ moral hazard, gave the 6,000 individuals a choice out of five individual insurance plans, covering the same services and reimbursing the providers for the full amount they charged. The only difference among the plans was copayments. Four plans had copayments which ranged from 25% to 95% of the medical bill, up to a maximum of $1,000 out-of-pocket payment per individual per year. Copayments could be very high, therefore. No wonder the Rand experiment proved “moral hazard,” showing that those who had all their care for free would incur 30% higher medical costs (Dranove, D.: ibid., pp. 30–31).

    Google Scholar 

  32. Mossialos, E. and Le Grand, J.: ibid., p. 64.

    Google Scholar 

  33. Järvelin, J.: ibid., p. 37.

    Google Scholar 

  34. European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 42.

    Google Scholar 

  35. Hjortsberg, C. and Ghatnekar, O.: ibid., p. 69.

    Google Scholar 

  36. OECD: The Reform of Health Care Systems: A Review of Seventeen OECD Countries, ibid., p. 200.

    Google Scholar 

  37. Saltman, R. B. and Figueras, J.: ibid., p. 79. Louckx points to two other ways of controlling the demand side: prevention and information (Louckx, F.: ibid., p. 189).

    Google Scholar 

  38. Raad voor de Volksgezondheid en Zorg: Gepaste Zorg, Zoetermeer, 2004, pp. 9 and 24.

    Google Scholar 

  39. Saltman, R. B. and Figueras, J.: ibid., p. 100.

    Google Scholar 

  40. Robinson, R.: ibid., p. 181.

    Google Scholar 

  41. Mossialos, E. and Le Grand, J.: ibid., p. 83.

    Google Scholar 

  42. Mossialos, E. and Dixon, A.: Funding Health Care in Europe: Weighing up the Options, in: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J., (eds.): ibid., p. 283.

    Google Scholar 

  43. Figueras, J., Saltman, R. B., Busse, R., and Dubois, H. F. W.: Patterns and Performance in Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 112.

    Google Scholar 

  44. Robinson, R.: ibid., p. 178.

    Google Scholar 

  45. Coulter, A. and Magee, H.: ibid., p. 139.

    Google Scholar 

  46. Paterson, I. and Judge, K.: Equality of Access to Healthcare, in: Mackenbach, J. and Bakker, M., (eds.): Reducing Inequalities in Health: A European Perspective, Routledge, 2002, p. 172.

    Google Scholar 

  47. European Observatory on Health Care Systems: Health Care Systems in Transition: Germany, 2000, ibid., p. 113.

    Google Scholar 

  48. Berg, M. and Grinten, T. van der: ibid., pp. 133–134.

    Google Scholar 

  49. For an extensive discourse on rationing in health care see: Feuerstein, G. and Kuhlmann, E., (eds.): Rationierung im Gesundheitswesen, Ullstein Medical, 1998.

    Google Scholar 

  50. Feuerstein, G. and Kuhlmann, E., (eds.): ibid., p. 195.

    Google Scholar 

  51. Rodwin, V. G.: The Rise of Managed Care in the United States: Lessons for French Health Policy, in: Altenstetter, Ch. and Björkman, J. M., (eds.): ibid., p. 51.

    Google Scholar 

  52. Sandier, S., Paris, V., and Polton, D.: ibid., p. 41.

    Google Scholar 

  53. Casasnovas, G. L. I.: Health Care and Cost Containment in Spain, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 430.

    Google Scholar 

  54. Ziekenfondsraad: Tweede Evaluatie Beperking Aanspraak Tandheelkunde per 1 januari 1995, Amstelveen, publikatienummer 1996/707, p. 8.

    Google Scholar 

  55. Mossialos, E. and Thomson, S. M. S.: Voluntary Health Insurance in the European Union, in: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J., (eds.): ibid., p. 153.

    Google Scholar 

  56. Mackenbach, J. P.: Hoe kan de Gezondheidszorg bijdragen aan het verkleinen van social-economische Gezondheidsverschillen? in: Stronks, K. and Hulshof, J., (eds.): ibid., p. 114.

    Google Scholar 

  57. European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 44.

    Google Scholar 

  58. Donatini, A., Rico, A., D’Ambrosio, M. M., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., p. 63.

    Google Scholar 

  59. Mossialos, E. and Thomson, S. M. S.: ibid., p. 153.

    Google Scholar 

  60. Colombo, F. and Tapay, N.: Private Health Insurance in Ireland: A Case Study, OECD Working Paper No. 10, Directorate for Employment, Labour and Social Affairs, Paris, February 2004, p. 4.

    Google Scholar 

  61. Mossialos, E. and Thomson, S. M. S.: ibid., pp. 148–149.

    Google Scholar 

  62. Jones, A. and Rice, N.: ibid., pp. 89–90.

    Google Scholar 

  63. European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 25.

    Google Scholar 

  64. European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 60.

    Google Scholar 

  65. Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 9.

    Google Scholar 

  66. Donatini, A., Rico, A., D’Ambrosio, M. M., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., p. 107.

    Google Scholar 

  67. Hjortsberg, C. and Ghatnekar, O.: ibid., p. 78.

    Google Scholar 

  68. Coulter, A. and Magee, H., (eds.): ibid., pp. 139–140.

    Google Scholar 

  69. Coulter, A. and Magee, H., (eds.): ibid., p. 132.

    Google Scholar 

  70. Sandier, S., Paris, V., and Polton, D.: ibid., p. 119.

    Google Scholar 

  71. See for the accumulative effects regarding elderly people in the Netherlands: Sociaal en Cultureel Planbureau: Rapportage Ouderen 1996, Rijswijk, 1997, chapter 6.

    Google Scholar 

  72. Therefore there are people who prefer to speak of healthy public policy instead of health policy. In this regard, see, for example: Marmor, T. R. and Boyum, D.: Medical Care and Public Policy: The Benefits and Burdens of Asking Fundamental Questions, in: Gunning-Schepers, L. J., Kronjee, G. J., Spasoff, R. A., (eds.): Fundamental Questions about the Future of Health Care, Netherlands Scientific Council for Government Policy, The Hague, 1996, pp. 89–103.

    Google Scholar 

  73. Engbersen, G., Vrooman, J. C., and Snel, E.: Arm Nederland: Het eerste Jaarrapport Armoede en Sociale Uitsluiting, the Hague, 1996, pp. 110–111.

    Google Scholar 

  74. Algemeen Verslag over de Armoede (General Report on Poverty), on instructions from the Minister of Social Integration, compiled by the King Baudouin Foundation in cooperation with ATD Fourth World Belgium and the Association of Belgian Cities and Municipalities, Social Welfare Department, 1995, pp. 120–153.

    Google Scholar 

  75. “L’hôpital et l’access et l’exclusion aux soins des plus dé munis,” in: Revue Hospitalière de France, no. 6, Novembre/Décembre, 1995, pp. 628–635.

    Google Scholar 

  76. For example, see (1) Kam, F. de: Keuzes in de Zorg, in: Economisch-Statistische Berichten, 31 August 1994, p. 766; (2) Saltman, R. B.: A Conceptual Overview of Recent Health Care Reforms, in: European Journal of Public Health, volume 4, 1994, no. 4, pp. 287–293.

    Google Scholar 

  77. Congress of Local and Regional Authorities of Europe, Strasbourg, 8–9 February 1996.

    Google Scholar 

  78. International Association of Mutual Insurance Companies, Brussels, 13–14 June 1996.

    Google Scholar 

  79. Interuniversity Centre for Social Science and Methodology, Groningen, 26–28 June 1996.

    Google Scholar 

  80. European Social Services Conference, London, 3–4 July 1996.

    Google Scholar 

  81. In this connection, see: Donovan, J. and Coast, J.: Public Preferences in Priority Setting: Unresolved Issues, in: Malek, M., (ed.): Priority Setting in Health Care, West Sussex, 1994, pp. 32–43.

    Google Scholar 

  82. Quoted in: Poorthuis, F.: Is de Gezondheidszorg te duur? in: Intermediair, volume 46, 13 November 1987, p. 7.

    Google Scholar 

  83. Staatscourant, 18 May 1995.

    Google Scholar 

  84. Nieuwe Noordhollandse Courant, 13 March 1996.

    Google Scholar 

  85. Nieuwe Noordhollandse Courant, 27 March 1996.

    Google Scholar 

  86. NRC/Handelsblad, 21 June 1996.

    Google Scholar 

  87. Paterson, I. and Judge, K.: Equality of Access to Health Care, in: Mackenbach, J. and Bakker, M., (eds.): ibid., p. 171.

    Google Scholar 

  88. Figueras, J., Saltman, R. B., Busse, R., and Dubois, H. F. W.: Patterns and Performance in Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 115.

    Google Scholar 

  89. Coulter, A. and Magee, H.: Key Issues for European Patients, in: Coulter, A. and Magee, H., (eds.): ibid., pp. 233–235.

    Google Scholar 

  90. Walshe, K.: ibid., p. 9.

    Google Scholar 

  91. Walshe, K.: ibid., p. 77.

    Google Scholar 

  92. Walshe, K.: ibid., p. 65.

    Google Scholar 

  93. Walshe, K.: ibid., p. 227.

    Google Scholar 

  94. Walshe, K.: ibid., pp. 101–102.

    Google Scholar 

  95. Walshe, K.: ibid., p. 228.

    Google Scholar 

  96. Ludmerer, K. M.: ibid., p. 277.

    Google Scholar 

  97. Walshe, K.: ibid., p. 57.

    Google Scholar 

  98. OECD: New Directions in Health Policy, ibid., p. 34.

    Google Scholar 

  99. Walshe, K.: ibid., p. 127.

    Google Scholar 

  100. Walshe, K.: ibid., p. 151.

    Google Scholar 

  101. Walshe, K.: ibid., pp. 152–153.

    Google Scholar 

  102. Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., pp. 30–31.

    Google Scholar 

  103. Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., pp. 21–24.

    Google Scholar 

  104. In: Trappenburg, M.: ibid., pp. 21–22.

    Google Scholar 

  105. European Observatory on Health Care Systems: Health Care Systems in Transition: Belgium, 2000, ibid., pp. 16–17.

    Google Scholar 

  106. Saltman, R. B. and Busse, R.: ibid., p. 4.

    Google Scholar 

  107. Glied, S.: ibid., pp. 38–39.

    Google Scholar 

  108. In this respect, Glied argues that there is evidence that tends to rebut Baumol’s hypothesis to medicine. Following Baumol, he would have predicted a widening gap between medical and other prices in a period of rapid productivity growth. In the 1980s, however, when industrial productivity increases were minimal, medical prices grew relatively more quickly than they had in the 1960s. The 1980s, however, was also the time when, through the introduction of important new health care technologies, health care became a curing industry (Glied, S.: ibid., p. 107).

    Google Scholar 

  109. Secretary of State for Health: The New NHS: Modern—Dependable, ibid., p. 75.

    Google Scholar 

  110. Ministerie van Volksgezondheid, Welzijn en Sport: Minder Regels, Meer Zorg, Eindrapport van de Commissie Terugdringing Administratieve Lasten Zorgsector, Den Haag, 2002.

    Google Scholar 

  111. Walshe, K.: ibid., p. 77.

    Google Scholar 

  112. Walshe, K.: ibid., p. 8.

    Google Scholar 

  113. Dranove, D.: ibid., p. 110.

    Google Scholar 

  114. Walburg, J.A.: Uitkomstenmanagement in de Gezondheidszorg: Het Opbouwen van Lerende Teams in Zorgorganisaties, Elsevier Gezondheidszorg, hoofdstuk 3. Also see: Dranove, D.: ibid., pp. 144–146.

    Google Scholar 

  115. There is some evidence on the relation between processes and outcomes. A Harvard study found that substandard processes were responsible for more than one-fourth of all adverse inpatient events, whereas another study concluded that patients suffered fewer inpatient complications when their physicians followed clinical guidelines (Dranove, D.: ibid., p. 145).

    Google Scholar 

  116. Weggeman, M.: Leidinggeven aan Professionals: Het Verzilveren van Creativiteit, Kluwer Bedrijfswetenschappen, 1993, p. 17.

    Google Scholar 

  117. Dranove, D.: ibid., p. 83.

    Google Scholar 

  118. Dranove, D.: ibid., p. 101.

    Google Scholar 

  119. Walshe, K.: ibid., p. 160.

    Google Scholar 

  120. Walshe, K.: ibid., p. 161.

    Google Scholar 

  121. Dranove, D.: ibid., p. 137.

    Google Scholar 

  122. Dranove, D.: ibid., p. 93.

    Google Scholar 

  123. In this respect, see: Walburg, J. A.: ibid.

    Google Scholar 

  124. Dranove, D.: ibid., pp. 87–89.

    Google Scholar 

  125. Dranove, D.: ibid., p. 65.

    Google Scholar 

  126. Dranove, D.: ibid., p. 53.

    Google Scholar 

  127. Dranove, D.: ibid., p. 114.

    Google Scholar 

  128. Cookson, R., Goddard, M., and Gravelle, H.: ibid., pp. 131–132.

    Google Scholar 

  129. Dranove, D.: ibid., chapter 6.

    Google Scholar 

  130. Dranove, D.: ibid., p. 159.

    Google Scholar 

  131. Ludmerer, K. M.: ibid., p. 350.

    Google Scholar 

  132. Marmor, Th. R.: Global Health Policy Reform: Mythology or Learning Opportunity, in: Altenstetter, Ch. and Björkman, J.W., (eds.): ibid., p. 350.

    Google Scholar 

  133. In this respect, see: Castles, F. G.: The Future of the Welfare State: Crisis Myths and Crisis Realities, Oxford University Press, 2004.

    Google Scholar 

  134. Glied, S.: ibid., pp. 84–85.

    Google Scholar 

  135. In this respect, see: Sparrow, M. K.: ibid., p. 35.

    Google Scholar 

  136. Wasem, J., Greß, S., and Okma, K.G. H.: The Role of Private Health Insurance in Social Health Insurance Countries, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 236.

    Google Scholar 

  137. In: Saltman, R. B.: Assessing Social Health Insurance Systems: Present and Future Policy Issues, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 145.

    Google Scholar 

  138. See: Saltman, R. B.: Assessing Social Health Insurance Systems: Present and Future Policy Issues, ibid., pp. 145–150.

    Google Scholar 

  139. Feuerstein, G. and Kuhlmann, E., (eds.): ibid., p. 24.

    Google Scholar 

  140. Trappenburg, M.: ibid., p. 26.

    Google Scholar 

  141. Bongers, I. M. B., Weert, C. M. C. van, Vis, C. M., Garretsen, H. F. L., and Das, M.: Kwaliteit en Kwantiteit van de Gezondheidszorg en actuele Beleidsontwikkelingen in de Gezondheidszorg in 2005: Nederlanders aan het Woord, Universiteit van Tilburg, 2005.

    Google Scholar 

  142. Health Care 2000: UK Health and Healthcare Services: Challenges and Policy Options, London, 1995, pp. 4–5.

    Google Scholar 

  143. Hofmarcher, M. M.: Cross-Section Analysis of Health Spending with Special Regard to Trends in Austria, Institute for Advanced Studies, Vienna, Economic Series, No. 70, 1999, p. 1.

    Google Scholar 

  144. Turner, A.: ibid., p. 95.

    Google Scholar 

  145. Evans, R. G. and Stoddart, G. L.: Producing Health, Consuming Health Care, in: Evans, R. G., Barer, M. L., Marmor, Th. R., (eds.): ibid. pp. 36–37.

    Google Scholar 

  146. Böhlke, R., Söhnle, N., and Viering, S.: Gesundheitsversorgung 2020. Konzentriert. Marktorientiert. Saniert, Ernst & Young, Frankfurt am Main, 2005.

    Google Scholar 

  147. Vathorst, S. van der: ibid., p. 9.

    Google Scholar 

  148. The term is from: Schrijvers, A. J. P.: Een Kathedraal van Zorg, ibid.

    Google Scholar 

  149. The term is from: Turner, A.: ibid., p. 97.

    Google Scholar 

  150. Turner, A.: ibid., p. 96.

    Google Scholar 

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(2007). The Effects. In: Trends in EU Health Care Systems. Springer, New York, NY. https://doi.org/10.1007/978-0-387-32748-8_10

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