Health care reforms: the unfinished agenda.
A number of similar trends emerge in the development of major reform programs in all Western societies: (1) convergence and divergence: whether intentionally or not, the reform programs follow the proposed general directions across countries. This convergence is challenged by an opposite trend towards divergence through regionalization; (2) politics: the interference of the political process and of government coalitions is manifest in health policy making; (3) competition: the movement away from the public integrated model towards the public contract model is occurring in National Health Service type systems as well as in Health Insurance Systems; (4) privatization: the increase of the private sector is encouraged in all European countries by a variety of mechanisms such as opting-out and tax concessions; (5) inequity: gains in efficiency entail a decrease in availability and accessibility of high quality care among the different population groups; (6) management costs: cost-containment efforts lead to an increase in management costs especially of management information both in real money and human resources; (7) power shifts: there is a reorientation of the flux of money throughout the system with shifts in authority away from the traditional power groups; and (8) public deficits: concern about the reduction of public deficits prevails over cost-effectiveness, or macro-efficiency prevails over micro-efficiency.
Defever
M
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Department of Public Health, University of Leuven, Belgium.
D004465:Economic Competition; D005060:Europe; D005380:Financing, Government; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D006297:Health Services Accessibility; D007348:Insurance, Health; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration; D011050:Policy Making; D011057:Politics; D011209:Power, Psychological; D017149:Private Sector; D011332:Privatization; D017150:Public Sector; D013222:State Medicine / Q000191:economics / Q000458:organization & administration