Analyzing The Evidence On European Health Care Reforms

Abstract

PROLOGUE: What level of government regulation and/or intervention is optimal for a successful health care system? This paper sheds some light on the subject by reporting the results of a broad survey of health care systems in western Europe. The project drew together what the authors call the available “epidemiological, sociological, organizational behavior, and management evidence” as well as financial and economic information about these systems. Despite the diversity of the nations studied, some overarching themes emerge among nations that have had success reforming their health care systems. Of particular interest to U.S. policymakers, the authors discuss the relative success of supply-side reforms as opposed to cost sharing and other demand-side tactics. Richard Saltman and Josep Figueras are affiliated with the Health Systems Analysis Unit of the World Health Organization (WHO)/Regional Office for Europe in Copenhagen, Denmark. They are co-project leaders of that office's ongoing study of health care reforms. Saltman is also professor of health policy and management at the Rollins School of Public Health of Emory University in Atlanta and has been a consultant to health system reform projects for the Organization for Economic Cooperation and Development (OECD) and the World Bank. He holds a doctorate in political science from Stanford University. In addition to his position as regional adviser for health systems analysis at WHO, Josep Figueras is a lecturer in health services management at the London School of Hygiene and Tropical Medicine. He received a doctorate in health planning and financing from London University. ABSTRACT: Health system reform, in Europe as elsewhere, has often been influenced as much by theory and conjecture as by fact and experience. In a study published in September 1997, the Regional Office for Europe of the World Health Organization (WHO) drew together the available evidence about the health care systems in the fifty-one countries of the European region. This paper focuses on western European countries. It reviews a variety of policy strategies and then explores implications from this European experience for the formulation of U.S. health care policy.