Abstract :
Industrialised countries face similar challenges for improving the
performance of their health system. Nevertheless, the nature and intensity of
the reforms required are largely determined by each country’s basic social
security model. Most reforms in Beveridge-type systems have sought to
increase choice and reduce waiting times while those in major Bismarck-type
systems have focused on cost control by constraining the choice of providers.
This paper looks at the main differences in performance of five countries and
reviews their recent reform experience, focusing on three questions: Are there
systematic differences in performance of Beveridge and Bismarck-type systems?
What are the key parameters of healthcare system, which underlie these
differences? Have recent reforms been effective?
Our results do not suggest that one system-type performs consistently
better than the other. In part, this may be explained by the heterogeneity in
organisational design and governance both within and across these systems.
Insufficient attention to those structural differences may explain the limited
success of a number of recent reforms. Thus, while countries may share
similar problems in terms of improving healthcare performance, adopting
a ‘copy-and-paste’ approach to healthcare reform is likely to be ineffective.
