Advertisement

Health Care Reforms

Chapter
  • 766 Downloads

Abstract

The changes that have occurred, and still are occurring, in EU health care systems since the beginning of the 1980s may lead one to conclude without exaggeration that health care-whether examined from the delivery, the financial, or the organizational perspective-finds itself in turbulent times. If one analyzed developments since 1980 in detail, one could easily come up with several hundred reforms. And if one were to include the different ways EU governments are pursuing current reform objectives, the list would be extended considerably. Analyzing health care reforms this way, however, would lead to an unreadably dense and very topical inventory of facts, an inventory which, for that matter, would be outdated immediately after completion.

Keywords

Health Care Health Technology Assessment Health Care Delivery Private Initiative Cost Containment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

Chapter 9

  1. 1.
    I follow Saltman and Figueras, who define reform as “a process that involves sustained and profound institutional and structural change, led by government and seeking to attain a series of explicit policy objectives” (Saltman, R. B. and Figueras, J.: ibid., p. 3).Google Scholar
  2. 3.
    Altenstetter, Ch.: Health Policy-Making in Germany: Stability and Dynamics, in: Altenstetter, Ch. and Björkman, J.W., (eds.): ibid., pp. 143–144.Google Scholar
  3. 4.
    See: Scrivens, E.: ibid., chapter 2.Google Scholar
  4. 5.
    Plumptre and Graham define governance as “the process whereby, within accepted traditions and institutional frameworks, interests are articulated by different sectors of society, decisions are taken, and decision-makers are held to account” (Chinitz, D., Wismar, M., and Le Pen, C.: Governance and (Self-) Regulation in Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras J., (eds.): ibid., p. 156).Google Scholar
  5. 6.
    Scrivens, E.: ibid., p. 19. It has been suggested that the origins of modern corporate governance stem from the Watergate scandal in the United States (Scrivens, E.: ibid., p. 20).Google Scholar
  6. 7.
    Scrivens, E.: ibid., p. 18.Google Scholar
  7. 8.
    British Ministry of Health: The New NHS: Modern-Dependable, London, 1997.Google Scholar
  8. 9.
    British Ministry of Health: The New NHS: Modern-Dependable, ibid., pp. 48–49.Google Scholar
  9. 10.
    Omachonu, V. K.: Total Quality and Productivity Management in Health Care Organizations, Institute of Industrial Engineers, Georgia, 1991, pp. 77–78.Google Scholar
  10. 11.
    Hjortsberg, C. and Ghatnekar, O.: Health Care Systems in Transition: Sweden 2001, in: Rico, A., Wisbaum, W. and Cetani, T., (eds.): European Observatory on Health Systems, WHO Regional Office for Europe, Copenhagen, 2001, p. 54.Google Scholar
  11. 12.
    Hofmarcher, M. M. and Rack, H.: Health Care Systems in Transition: Austria 2001, in: Dixon, A., (ed.): European Observatory on Health Care Systems, WHO Regional Office for Europe, Copenhagen, 2001, p. 24.Google Scholar
  12. 13.
    Hofmarcher, M. M. and Rack, H.: ibid., p. 101.Google Scholar
  13. 14.
    Sandier, S., Paris, V., Polton, D.: ibid., p. 33.Google Scholar
  14. 15.
    Exter, A. den, Hermans, H., Dosljak, M., and Busse, R.: Health Care Systems in Transition. Netherlands 2004, in: Busse, R., Ginneken, E. van, Schreyögg, J., Wisbaum, W., (eds.): European Observatory on Health Care Systems, WHO Regional Office for Europe, Copenhagen, 2004, p. 22.Google Scholar
  15. 16.
    Exter, A. den, Hermans, H., Dosljak, M., and Busse, R.: Ginneken, E. van, Schreyögg, J., Wisbaum, W., (eds.): European Observatory on Health Care Systems, WHO Regional Office for Europe, Copenhagen, 2004 ibid., p. 26.Google Scholar
  16. 17.
    Health Policy Monitor, international network for Health Policy & Reform, Bertelsmann Stiftung, survey, January 2003.Google Scholar
  17. 19.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom 1999 WHO Regional Office for Europe, Copenhagen, 1999, p. 37.Google Scholar
  18. 20.
    Hofmarcher, M. M. and Rack, H.: ibid., p. 40.Google Scholar
  19. 21.
    Vallgärda, S. Krasnik, A., and Vrangbæk, K.: ibid., p. 79.Google Scholar
  20. 22.
    Järvelin, J.: Health Care Systems in Transition: Finland 2002, European Observatory on Health Care Systems, WHO Regional Office for Europe, Copenhagen, 2002, p. 27.Google Scholar
  21. 23.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: Health Care Systems in Transition: Portugal 2004, European Observatory on Health Care Systems, WHO Regional Office for Europe, p. 26.Google Scholar
  22. 24.
    Glied, S.: ibid., p. 48.Google Scholar
  23. 25.
    Wildner, M., Exter, A. P. den, and Kraan, W. G. M. van der: The Changing Role of the Individual in Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 257.Google Scholar
  24. 26.
    Saltman, R. B. and Busse, R.: Balancing Regulation and Entrepreneurialism in Europe’s Health Sector: Theory and Practice, in: Saltman, R. B., Busse, R., Mossialos, E., (eds.): Regulating Entrepreneurial Behaviour in European Health Care Systems, Open University Press, 2003, p. 47.Google Scholar
  25. 27.
    Legemaate, J.: Regelgeving in Nederland, in: Lens, P. and Kahn, Ph. S., (eds.): ibid., p. 63.Google Scholar
  26. 28.
    Scrivens, E.: Accreditation and the Regulation of Quality in Health Services, in: Saltman, R. B., Busse, R., Mossialos, E., (eds.): ibid., p. 95.Google Scholar
  27. 29.
    Crul, B. V. M.: De Media en de Disfunctionerende Dokter, in: Lens, P. and Kahn, Ph. S., (eds.): ibid., p. 470.Google Scholar
  28. 30.
    Most Swedish county councils have developed their own website to inform citizens about health matters, patients’ rights, and the structure and organization of the health care system (Coulter, A. and Magee, H., (eds.): ibid., p. 147.Google Scholar
  29. 31.
    Coulter, A. and Magee, H., (eds.): ibid., p. 44.Google Scholar
  30. 32.
    Dranove, D.: ibid., p. 13.Google Scholar
  31. 33.
    Coulter, A. and Magee, H., (eds.): ibid., p. 46.Google Scholar
  32. 34.
    Hofmarcher, M. M. and Rack, H.: ibid., p. 19.Google Scholar
  33. 35.
    Coulter, A. and Magee, H., (eds.): ibid., p. 128.Google Scholar
  34. 36.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., pp. 31–32.Google Scholar
  35. 37.
    Mossialos, E. and Le Grand, J., (eds.): ibid., p. 33.Google Scholar
  36. 38.
    Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 25.Google Scholar
  37. 39.
    Håkansson, S. and Nordling, S.: The Health System of Sweden, in: Raffel, M. W., (ed.), ibid., p. 205.Google Scholar
  38. 40.
    Hjortsberg, C. and Ghatnekar, O.: ibid., pp. 21–23.Google Scholar
  39. 41.
    Järvelin, J.: ibid., p. 28.Google Scholar
  40. 42.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., pp. 31–32.Google Scholar
  41. 43.
    García-Altés, A.: Health Care Coverage Determinations in Spain, in: Stoltzfus Jost, T., (ed.): ibid., p. 158.Google Scholar
  42. 44.
    García-Altés, A.: ibid., p. 160.Google Scholar
  43. 45.
    García-Altés, A.: ibid., p. 160.Google Scholar
  44. 46.
    Scrivens, E.: ibid., p. 1.Google Scholar
  45. 47.
    Scrivens, E.: ibid., p. 17Google Scholar
  46. 48.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom 1999, ibid., pp. 18–19.Google Scholar
  47. 49.
    Walshe, K.: Regulating Health Care: A Prescription for Improvement? Open University Press, 2003, p. 12.Google Scholar
  48. 50.
    Cookson, R., Goddard, M., and Gravelle, H.: Regulating Health Care Markets, in: Smith, P. C., Ginelly, L., Sculpher, M., (eds.): ibid., pp. 122–123.Google Scholar
  49. 51.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Germany 2000, WHO Regional Office for Europe, Copenhagen, 2000.Google Scholar
  50. 52.
    Reid, T. R.: ibid., p. 159.Google Scholar
  51. 53.
    OECD: Internal Markets in the Making: Health Systems in Canada, Iceland and the United Kingdom, Health Policy Studies No. 6, OECD, Paris, 1995, p. 9.Google Scholar
  52. 54.
    OECD: Internal Markets in the Making: Health Systems in Canada, Iceland and the United Kingdom, ibid., p. 13.Google Scholar
  53. 55.
    OECD: Internal Markets in the Making: Health Systems in Canada, Iceland and the United Kingdom, ibid., pp. 9–27.Google Scholar
  54. 56.
    Hayman, H.: ibid., p. 164.Google Scholar
  55. 57.
    Blair, T.: New Britain: My Vision of a Young Country, London, 1996, p. 69.Google Scholar
  56. 58.
    Wheen, F.: ibid., p. 219.Google Scholar
  57. 59.
    Wheen, F.: ibid., p. 222.Google Scholar
  58. 60.
    The National Audit Office calculated that 35% of the savings were used to improve fund-holders’ surgeries, 25% for surgeries’ design, and 15% for medical instruments (National Audit Office: General Practitioner: Fundholding in England, Report by the Comptroller and Auditor General, London, HMSO, HC 51, session 1994-5, 9 December 1994).Google Scholar
  59. 61.
    OECD: Internal Markets in the Making: Health Systems in Canada, Iceland and the United Kingdom, ibid., p. 22.Google Scholar
  60. 62.
    Donatoni, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: Health Care Systems in Transition: Italy 2001, in: Rico, A. and Cetani, T., (eds.): European Observatory on Health Care Systems, WHO Regional Office for Europe, Copenhagen, 2001, p. 32.Google Scholar
  61. 63.
    Donatoni, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., p. 93.Google Scholar
  62. 64.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., pp. 91–92.Google Scholar
  63. 65.
    Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 81. Austria also outsourced these services in the late 1980s and early 1990s (Hofmarcher, M. M. and Rack, H.: ibid., p. 102).Google Scholar
  64. 66.
    Hjortsberg, C. and Ghatnekar, O.: ibid., pp. 86–88.Google Scholar
  65. 67.
    Hjortsberg, C. and Ghatnekar, O.: ibid., p. 19.Google Scholar
  66. 68.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Spain 2000, ibid., pp. 106–109.Google Scholar
  67. 69.
    Exter, A. den, Hermans, H., Dosljak, M., Busse, R.: ibid., p. 114.Google Scholar
  68. 70.
    Sandier, S., Paris, V., Polton, D.: ibid., p. 118.Google Scholar
  69. 71.
    For the Netherlands see: Exter, A. den, Hermans, H., Dosljak, M., and Busse, O.: ibid., pp. 124–125.Google Scholar
  70. 72.
    Johson, H. T. and Kaplan, R. S.: Relevance Lost: The Rise and Fall of Management Accounting, Harvard Business School Press, 1987, p. 260.Google Scholar
  71. 73.
    Johson, H.Y. and Kaplan, R. S.: ibid., p. 155.Google Scholar
  72. 74.
    OECD: New Directions in Health Care Policy, Health Policy Studies No. 7, OECD, Paris, 1995, p. 60.Google Scholar
  73. 75.
    Greiner, W. and Schulenburg, J-M Graf v. d.: The Health System of Germany, in: Raffel, M.W., (ed.), ibid., p. 88.Google Scholar
  74. 76.
    Sandier, S., Paris, V., Polton, D.: ibid., pp. 70–73.Google Scholar
  75. 77.
    Hofmarcher, M. M. and Rack, H.: ibid., p. 62.Google Scholar
  76. 78.
    World Health Organization: Health Care Systems in Transition: Greece 1996, WHO Regional Office for Europe, 1996, p. 13.Google Scholar
  77. 79.
    García-Altés, A.: ibid., p. 160.Google Scholar
  78. 80.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom 1999, ibid., p. 68.Google Scholar
  79. 81.
    Boelens, E. and Schreuder, R. F.: Platform Privatisering in de Gezondheidszorg: Terreinverkenning en Aandachtspunten voor Beleid, Health Management Forum, 1999, chapter 3.Google Scholar
  80. 82.
    In this respect, 1999 research among 2,400 people living in Stockholm showed that 25% of the respondents thought that they had to wait too long to be able to see their general practitioner. A similar result came out of national research among 3,200 Swedes one year later. The number of people who thought their waiting time to see a doctor had become unacceptably long doubled between 1994 and 1999 (Coulter, A. and Magee, H., (eds.): ibid., p. 136).Google Scholar
  81. 83.
    College Bouw Ziekenhuisvoorzieningen: Signaleringsrapport het zelfstandig Behandelcentrum: van noodzakelijk Kwaad tot nuttig Goed?, Voorstel voor een nieuw Beoordelingskader, Utrecht, 2003.Google Scholar
  82. 84.
    Brief van de minister van Volksgezondheid, Welzijn en Sport aan de Voorzitter van de Tweede Kamer der Staten-Generaal, de dato 31_maart 2003 (kenmerk: CZ/IZ-2369484).Google Scholar
  83. 85.
    In: Edwards, P., Shaoul, J., Stafford, A., Arblaster, L.: Evaluating the Operation of PFI in Roads and Hospitals, the Association of Chartered Certified Accountants, London, 2004, p. 15.Google Scholar
  84. 86.
    In fact, there are at least seven types of PPS, being (1) Design and Construct; (2) Operate and Maintain; (3) Design, Build, Operate; (4) Build, Own, Operate, Transfer; (5) Build, Own, Operate; (6) Lease, Own, Operate; and (7) Alliance (College Bouw Ziekenhuisvoorzieningen: Publiek Private Samenwerking in de Gezondheidszorg. Een vergelijkende Studie, Signaleringsrapport, Rapportnummer 568, Utrecht, 2004, pp. 4–5).Google Scholar
  85. 87.
    Under Private Finance Initiatives, “the public sector procures a capital asset and non-core services from the private sector on a long-term contract, typically at least 30 years, in return for an annual payment” (Edwards, P., Shaoul, J., Stafford, A., Arblaster, L.: ibid., p. 7).Google Scholar
  86. 88.
    Edwards, P., Shaoul, J., Stafford, A., Arblaster, L.: ibid., p. 8.Google Scholar
  87. 89.
    Edwards, P., Shaoul, J., Stafford, A., Arblaster, L.: ibid., p. 135.Google Scholar
  88. 90.
    Busse, R., Grinten, T. van der, and Svensson, P.-G.: Regulating Entrepreneurial Behaviour in Hospitals: Theory and Practice, in: Saltman, R. B., Busse, R., Mossialos, E., (eds.): ibid., p. 137.Google Scholar
  89. 91.
    Edwards, P., Shaoul, J., Stafford, A., Arblaster, L.: ibid., p. 173.Google Scholar
  90. 92.
    Edwards, P., Shaoul, J., Stafford, A., Arblaster, L.: ibid., p. 174.Google Scholar
  91. 93.
    College Bouw Ziekenhuisvoorzieningen: Publiek Private Samenwerking in de Gezondheidszorg. Een vergelijkende Studie, Signaleringsrapport, Rapportnummer 568, Utrecht, 2004, p. VI.Google Scholar
  92. 94.
    Edwards, P., Shaoul, J., Stafford, A., Arblaster, L.: ibid., p. 144.Google Scholar
  93. 95.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., pp. 38–39.Google Scholar
  94. 96.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Spain, 2000, ibid., p. 119.Google Scholar
  95. 97.
    Donatini, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., pp. 44–45.Google Scholar
  96. 98.
    A similar survey of 1993 showed that 55% of the respondents argued that the sickness funds should pay for everything, with 41% excluding coverage for certain diseases (European Observatory on Health Care Systems: Health Care Systems in Transition: Germany, 2000, ibid., p. 44).Google Scholar
  97. 99.
    New, B. and Le Grand, J.: Rationing in the NHS: Principles & Pragmatism, King’s Fund, London, 1996, p. 17.Google Scholar
  98. 100.
    The Netherlands did so by organizing a public debate after the Dunning report was released in 1992. The British government encouraged health authorities to involve the general public in decisions about rationing and priority-setting. At the local level, the British applied numerous methods for eliciting the public’s view, including population surveys, public meetings, citizens’ juries, et cetera (The European Observatory on Health Care Systems: Health Care System in Transition: United Kingdom 1999, ibid., p. 39).Google Scholar
  99. 101.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 35.Google Scholar
  100. 103.
    Järvelin, J.: ibid., p. 33.Google Scholar
  101. 104.
    Hjortsberg, C. and Ghatnekar, O.: ibid., pp. 27–28.Google Scholar
  102. 105.
    Gezondheidsraad: Grenzen van de Gezondheidszorg, Den Haag, 1986.Google Scholar
  103. 106.
    Government Committee on Choices in Health Care: Choices in Health Care, Ministry of Welfare, Health and Cultural Activities, Rijswijk, the Netherlands, 1992.Google Scholar
  104. 107.
    The European Observatory on Health Care Systems: Health Care System in Transition: United Kingdom, 1999, ibid., p. 40.Google Scholar
  105. 108.
    In: Standing Committee of the Hospitals of the European Union. Subcommittee on Economics and Planning: Hospitals and Health Care Rationing, Leuven, September 2000, p. 5.Google Scholar
  106. 109.
    New, B. and Le grand, J.: ibid.Google Scholar
  107. 110.
    Wille, E., (ed.): Rationierung im Gesundheitswesen und ihre Alternativen, Nomos Verlagsgesellschaft, Baden-Baden, 2003.Google Scholar
  108. 111.
    New, B. and Le Grand, J.: ibid., p. 21.Google Scholar
  109. 112.
    Standing Committee of the Hospitals of the European Union. Subcommittee on Economics and Planning: Hospital and Health Care Rationing, ibid., p. 12.Google Scholar
  110. 113.
    Berg and Van der Grinten distinguish between four types of strategy: (1) the introduction of health technology assessment, (2) assessment of the basic package, (3) the use of waiting lists, and (4) stimulating appropriate use of health care (Berg, M. and Grinten, T. van der: The Netherlands, in: Ham, Ch. and Glenn, R., (eds.): Reasonable Rationing: International Experience of Priority Setting in Health Care, Open University Press, 2003, p. 119).Google Scholar
  111. 114.
    As an example: The United Kingdom has a National Institute of Clinical Excellence (NICE) to evaluate drugs and technologies, which provides a mechanism to control their introduction and to support equity of access. Furthermore, Banta reports on several initiatives regarding technology assessment, coordinated through an international network (Banta, D.: ibid).Google Scholar
  112. 115.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Luxembourg, 1999, ibid., p. 49.Google Scholar
  113. 116.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Belgium, 2000, pp. 59–61.Google Scholar
  114. 117.
    Donatini, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., pp. 81–82.Google Scholar
  115. 118.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Spain, ibid., p. 99.Google Scholar
  116. 119.
    Stoltzfus Jost, T.: What Can We Learn From Our Country Studies? in: Stoltzfus Jost, T., (ed.): ibid., p. 240.Google Scholar
  117. 120.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, WHO Regional Office for Europe, p. 83.Google Scholar
  118. 122.
    Newdick, Ch.: Evaluating New Health Technology in the English National Health Service, in: Stoltzfus Jost, T., (ed.): ibid., p. 88.Google Scholar
  119. 123.
    Newdick, Ch.: ibid., p. 93.Google Scholar
  120. 124.
    In addition to NICE, the United Kingdom has a counterpart for social care with the establishment of the Social Care Institute for Excellence in 2001 (Scrivens, E.: ibid., p. 27).Google Scholar
  121. 125.
    Gibis, B., Koch-Wulkan, P., and Bultman, J.: Shifting Criteria for Benefit Decisions in Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 193.Google Scholar
  122. 126.
    For a detailed description, see: Carino, T., and Rutten, F.: Health Care Coverage in the Netherlands: The Dutch Drug Reimbursement Scheme (GVS), in: Stoltzfus Jost, T., (ed.): ibid., chapter 6.Google Scholar
  123. 127.
    Carino, T. and Rutten, F.: ibid., p. 137.Google Scholar
  124. 128.
    Carino, T. and Rutten, F.: ibid., p. 138.Google Scholar
  125. 129.
    Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 69.Google Scholar
  126. 130.
    Stoltzfus Jost, T., (ed.): ibid.Google Scholar
  127. 131.
    Raad voor de Volksgezondheid en Zorg: Technologische Innovatie in de Zorgsector, ibid., p. 72.Google Scholar
  128. 132.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., p. 72.Google Scholar
  129. 133.
    Stoltzfus Jost, T., (ed.): ibid., p. 254.Google Scholar
  130. 134.
    Carino, T. and Rutten, F.: ibid., p. 141.Google Scholar
  131. 135.
    Nederlandse Zorgfederatie: Gezondheidszorg in Tel 4, Utrecht, 1996, p. 193.Google Scholar
  132. 136.
    See for example: Nederlandse Zorgfederatie: Gezondheidszorg in Tel 6, Utrecht, 1998.Google Scholar
  133. 137.
    Vallgärda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 80.Google Scholar
  134. 138.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., pp. 62–64.Google Scholar
  135. 139.
    Hjortsberg, C. and Ghatnekar, O.: ibid., p. 81.Google Scholar
  136. 140.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., pp. 36–38.Google Scholar
  137. 141.
    Ham, Ch. and Coulter, A.: International Experience of Rationing, in: Ham, Ch. and Robert, G., (eds.): ibid., p. 8.Google Scholar
  138. 142.
    Appleby, J.: ibid., p. 135.Google Scholar
  139. 143.
    Berg, M. and Grinten, T. van der: ibid., p. 130.Google Scholar
  140. 144.
    Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., pp. 83–84.Google Scholar
  141. 145.
    Sandier, S., Paris, V., and Polton, D.: ibid., p. 65.Google Scholar
  142. 146.
    Sandier, S., Paris, V., and Polton, D.: ibid., p. 128.Google Scholar
  143. 147.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Belgium, 2000, ibid., pp. 75–77.Google Scholar
  144. 148.
    Järvelin, J.: ibid., p. 27.Google Scholar
  145. 149.
    Donatini, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., pp. 102–103.Google Scholar
  146. 150.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 23.Google Scholar
  147. 151.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., pp. 25 and 27.Google Scholar
  148. 152.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 28.Google Scholar
  149. 153.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 30.Google Scholar
  150. 154.
    White, S. and Stancombe, J.: Clinical Judgement in the Health and Welfare Professions: Extending the Evidence Base, Open University Press, 2003, p. 25.Google Scholar
  151. 155.
    Gunning-Schepers, L. J.: Verkleining van sociaal-economische Gezondheidsverschillen vanuit de Zorg: bestuurlijke en politieke implicaties, in: Stronks, K. and Hulshof, J., (eds.): De Kloof verkleinen. Theorie en Praktijk van de Strijd tegen sociaal-economische Gezondheidsverschillen, Van Gorcum, 2001, p. 132.Google Scholar
  152. 156.
    White, S. and Stancombe, J.: ibid., p. viii.Google Scholar
  153. 157.
    White, S. and Stancombe, J.: ibid., p. 20.Google Scholar
  154. 158.
    White, S. and Stancombe, J.: ibid., p. ix.Google Scholar
  155. 159.
    White, S. and Stancimbe, J.: ibid., p. 17.Google Scholar
  156. 160.
    Glied, S.: ibid., p. 72Google Scholar
  157. 161.
    Mossialos and Le Grand present a threefold classification of cost-containment measures: budget shifting, budget setting, and direct and indirect controls (Mossialos, E. and Le Grand, J.: ibid., p. 62).Google Scholar
  158. 162.
    Hofmarcher, M.M. and Durand-Zaleski, I.: Contracting and Paying Providers in Social Health Insurance Systems, in: Saltmans, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 220.Google Scholar
  159. 165.
    Reference-pricing is only useful if products are interchangeable because they have similar therapeutical effects or produce similar outcomes (Mossialos, E. and Mrazek, M.: Entrepreneurial Behaviour in Pharmaceutical Markets and the Effects of Regulation, in: Saltman, R. B., Busse, R., Mossialos, E., (eds.): ibid., p. 155).Google Scholar
  160. 168.
    Mossialos, E. and Mrazek, M.: ibid., p. 155.Google Scholar
  161. 170.
    Mossialos, E. and Le Grand, J., (eds.): ibid., p. 500.Google Scholar
  162. 173.
    Angell, M.: ibid., p. 219. President Clinton gave it a try with his plans for the establishment of a price-review board for drugs, but did not succeed (Greider, K.: The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers, Public Affairs, New York, 2003, p. 168).Google Scholar
  163. 174.
    Greider, K.: ibid., p. 1.Google Scholar
  164. 175.
    Angell, M.: ibid., p. xii.Google Scholar
  165. 176.
    Angell, M.: ibid., p. 198.Google Scholar
  166. 177.
    In the 1999–2000 election cycle, $85 million was contributed, of which $20 million was in direct contributions; the rest was “soft money” (Angell, M.: ibid., p. 200).Google Scholar
  167. 178.
    According to a 2003 PhRMA report (the Association of Pharmaceutical Research and Manufacturers of America), spending for fiscal influence in 2004 was budgeted at $150 million, of which $73 million would be spent at the federal level and $49 million at state levels (Angell, M.: ibid., p. 214).Google Scholar
  168. 179.
    Angell, M.: ibid., p. 139.Google Scholar
  169. 180.
    Angell, M.: ibid., p. 3. On the contrary, the share of prescription drugs remained fairly static during the period 1960–1980.Google Scholar
  170. 181.
    Coulter, A. and Magee, H., (eds.): ibid., p. 45.Google Scholar
  171. 182.
    Research from 1999 showed that 94% of health information magazines handed out by general practitioners in Berlin came from the pharmaceutical industry. In addition to this, the industry supplied 84% of the magazines that were available in the waiting rooms. People, in general, mistrusted this information, however (Coulter, A., and Magee, H., (eds.): ibid., p. 43).Google Scholar
  172. 183.
    Angell, M.: ibid., p. 10.Google Scholar
  173. 184.
    Huffington, A.: ibid., p. 121.Google Scholar
  174. 185.
    Angell, M.: ibid., p. 11.Google Scholar
  175. 186.
    All in all, about half of the larger drug companies are based in Europe (Angell, M.: The Truth about the Drug Companies: How They Deceive Us and What To Do About It, Random House, 2004, p. xvii).Google Scholar
  176. 187.
    Angell, M.: ibid., pp. 12–13.Google Scholar
  177. 188.
    Angell, M.: ibid.Google Scholar
  178. 189.
    According to Mossialos and Mrazek, 20 of the leading American pharmaceutical industries spent between 11% and 21% on research and development in 1997 (Mossialos, E. and Mrazek, M.: ibid., p. 147).Google Scholar
  179. 190.
    Other sources mention an amount of $500 million, while assuming that it takes between seven and ten years to bring a new chemical entity to the market (Mossialos, E. and Mrazek: ibid., p. 147).Google Scholar
  180. 191.
    Angell, M.: ibid., p. 65.Google Scholar
  181. 192.
    Angell, M.: ibid., p. 143.Google Scholar
  182. 193.
    Angell, M.: ibid., pp. 54–55. Mossialos and Mrazek mention a decrease in new chemical entities introduced on the world market from 100 in 1963 to 37 in 1998 (Mossialos, E. and Mrazek, M.: ibid., p. 148).Google Scholar
  183. 194.
    Greider, K.: ibid., p. 29.Google Scholar
  184. 195.
    Angell, M.: ibid., p. xviii.Google Scholar
  185. 196.
    Mossialos, E. and Mrazek, M.: ibid., p. 149.Google Scholar
  186. 197.
    Angell, M.: ibid., pp. 30–31.Google Scholar
  187. 198.
    Angell, M.: ibid., p. 86.Google Scholar
  188. 199.
    The former CEO of Bristol-Myers Squibb received almost $75 million in 2001, plus a similar amount of stock options. His colleague from Wyeth received a salary of $40 million, plus the same amount in stock options. Unexercised stock options held by the CEOs of the ten large American drug companies were valued on average to be $52 million in 2001 (Angell, M.: ibid., pp. 12 and 49).Google Scholar
  189. 200.
    Angell, M.: ibid., p. 92.Google Scholar
  190. 201.
    Huffington, A.: ibid., pp. 138–139.Google Scholar
  191. 202.
    Greider, K.: ibid., p. 171.Google Scholar
  192. 203.
    Angell, M.: ibid., pp. 235–236.Google Scholar
  193. 204.
    Greider, K.: ibid., p. 17.Google Scholar
  194. 205.
    De Volkskrant, 6 December 2004.Google Scholar
  195. 206.
    Even considerably higher than commercial banking, with 13.5% (Angell, M.: ibid., p. 11).Google Scholar
  196. 207.
    Regarding this, see, for example: (1) Lichtenberg, F. R.: The Economic and Human Impact of New Drugs, in: Journal of Clinical Psychiatry, 2003, 64(supplement 17), pp. 15–18; and (2) Goudriaan, R.: Recepten voor Extramuralisering van de Zorg, in: Economisch-Statistische Berichten, 26 November 2004, pp. 572–575.PubMedGoogle Scholar
  197. 208.
    Lichtenberg, F. R.: Availability of New drugs and Americans’ Ability to Work, in: JOEM, volume 47, no. 4, April 2005, pp. 373–380.PubMedCrossRefGoogle Scholar
  198. 209.
    Der Spiegel, February 2003, p. 73.Google Scholar
  199. 211.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Belgium 2000, WHO Regional Office for Europe, Copenhagen, 2000, p. 23.Google Scholar
  200. 212.
    Crainich, D. and Closon, M.-C.: Cost Containment and Health Care Reform in Belgium, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 254.Google Scholar
  201. 213.
    Donatini, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., p. 46.Google Scholar
  202. 214.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Germany, 2000, ibid., p. 47.Google Scholar
  203. 215.
    Hofmarcher, M. M. and Rack, H.: ibid., p. 35.Google Scholar
  204. 216.
    Appleby, J.: ibid., p. 144.Google Scholar
  205. 217.
    European Observatory on Health Care Systems: Health Care Systems in Transition, United Kingdom, 1999, ibid., p. 41.Google Scholar
  206. 218.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Belgium, 2000, ibid., pp. 25–26.Google Scholar
  207. 219.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 43.Google Scholar
  208. 220.
    Sandier, S., Paris, V., Polton, D.: ibid., pp. 44–45 (figure 4).Google Scholar
  209. 221.
    Hjortsberg, C. and Ghatnekar, O.: ibid., p. 30.Google Scholar
  210. 222.
    Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 31.Google Scholar
  211. 223.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., p. 37.Google Scholar
  212. 224.
    Hofmarcher, M. M. and Rack, H.: ibid., pp. 37–38Google Scholar
  213. 225.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., p. 37Google Scholar
  214. 226.
    Evans, G.: Financing Health Care:Taxation and the Alternatives, in: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J.: ibid., p. 47.Google Scholar
  215. 227.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Belgium, 2000, ibid., p. 25.Google Scholar
  216. 228.
    European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 44.Google Scholar
  217. 229.
    Donatini, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., p. 49.Google Scholar
  218. 230.
    Vallgårda, S., Krasnik, A., and Vrangbæk, K.: ibid., p. 31.Google Scholar
  219. 231.
    Hjortsberg, C. and Ghatnekar, O.: ibid., p. 30.Google Scholar
  220. 232.
    Donatini, A., Rico, A., D’Ambrosio, M.G., Scalzo, A. Lo, Orzella, L., Cicchetti, A., and Profili, S.: ibid., pp. 85–87.Google Scholar
  221. 233.
    Järvellin, J.: ibid., p. 76.Google Scholar
  222. 234.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Luxembourg, 1999, ibid., p. 51.Google Scholar
  223. 235.
    Maarse, J.A. M.: The Health System of the Netherlands, in: Raffel, M.W., (ed.), ibid., p. 144.Google Scholar
  224. 236.
    Wiley, M. M.: Hospital Budgeting and Financing using DRGs, in: Roger-France, F. H., Moor, G. de, Hofdijk, J., Jenkins, L., (eds.): Diagnosis Related Groups in Europe, ISBN 90-73045-01-0, Gent, 1989, p. 59.Google Scholar
  225. 237.
    According to Altenstetter and Björkman, ideas on managed care stem “from an oxymoronic mating of two major ‘faiths’ of the contemporary era: the virtues of the market as a mechanism to allocate costs as well as benefits efficiently; and the virtues of the directive state to ‘guide’ those allocations through efficacious regulation” (Altenstetter, Chr. and Björkman, J.W., (eds.): ibid., p. 7).Google Scholar
  226. 238.
    In 2002, 80% of employees were covered through managed care plans (Maynard, A. and Dixon, A.: ibid., p. 118).Google Scholar
  227. 239.
    In the year 2000, there were over 500 American HMOs with more than 60 million enrolees, while over 80% of the American population took part in some managed care plan (Dranove, D.: ibid., 67).Google Scholar
  228. 240.
    Furthermore, tens of millions of Americans had looser forms of managed care, such as preferred provider organizations and discounted fee-for-service (Ludmerer, K. M.: ibid., p. 353).Google Scholar
  229. 241.
    Rodwin, V.: The Rise of Managed Care in the United State: Lessons for French Health Policy, in: Altenstetter, Chr. and Björkman, J.W., (eds.): ibid., p. 16.Google Scholar
  230. 242.
    Feuerstein G. and Kuhlmann, E.: Der Rationierungsdiskurs: Eine Einleitung, in: Feuerstein, G. and Kuhlmann, E., (eds.): ibid., p. 3.Google Scholar
  231. 243.
    Dranove, D.: ibid., p. 8.Google Scholar
  232. 244.
    Dranove, D.: ibid., p. 62.Google Scholar
  233. 245.
    Ludmerer, K. M.: ibid., p. 351.Google Scholar
  234. 246.
    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. 143.Google Scholar
  235. 247.
    Bentes, M., Dias, C. M., Sakellarides, C., and Bankauskaite, V.: ibid., p. 81.Google Scholar
  236. 248.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Spain, 2000, ibid., p. 109.Google Scholar
  237. 249.
    Järvellin, J.: ibid., p. 77.Google Scholar
  238. 250.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Belgium, 2000, ibid., p. 70.Google Scholar
  239. 251.
    Hughes, J.: Health Expenditure and Cost Containment in Ireland, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 489.Google Scholar
  240. 252.
    Exter, A. den, Hermans, H., Dosljak, M., and Busse, R.: ibid., pp. 108–109.Google Scholar
  241. 253.
    Dranove, D.: ibid., p. 52.Google Scholar
  242. 254.
    Dranove, D.: ibid., pp. 103–104.Google Scholar
  243. 255.
    Contracts may be (1) block contracts, (2) cost-and-volume contracts, or (3) percase contracts. Block contracts couple finances to a range of services for citizens of a defined region. Cost-and-volume contracts specify the number of treatments or cases that a provider will deliver at an agreed price, whereas percase contracts define medical activity and expenditure at the level of an individual patient. The last type of contract causes considerable transaction costs. In practice, the British contracting system resulted in a new type of contract called the “sophisticated block” contract, which comes down to implementing a certain margin (floor or ceiling) in the contract (European Observatory on Health Care Systems: Health Care Systems in Transition: United Kingdom, 1999, ibid., p. 89).Google Scholar
  244. 257.
    Sandier, S., Paris, V., Polton, D.: ibid., p. 108.Google Scholar
  245. 258.
    European Observatory on Health Care Systems: Health Care Systems in Transition: Spain, 2000, ibid., p. 108.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Personalised recommendations