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Les réformes du service national de santé britannique : la fin d'un mythe ?

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  • Jacques Chaperon
  • Lise Rochaix

Abstract

[spa] Las reformas del servicio nacional de sanidad britanico : i el fin de un mito? . A menudo se opone el servicio de sanidad britanico a los sistemas de tipo seguro, como la Seguridad social francesa, en la cual quien proporciona los cuidados y quien reembolsa son dos entidades distintas. Tal distinciôn no tiene sentido en un sistema britanico casi totalmente financiado por el impuesto. . Sin embargo, este servicio de sanidad se encuentra con los mismos problemas de regulaciôn de los gastos y de eficacia que los otros sistemas. Dentro de este contexto, las reformas llevadas a cabo en la présente década ténia como fin la instauration de un casimercado dentro de una configuraciôn hasta entonces muy centralizada : restablecimiento de cierta separation entre compradores y prestatarios de servicios de sanidad ; funciôn y responsabilidad superiores del internista. . A mâs largo plazo, este reparto de la responsabilidad deberia contribuir a una mayor eficacia del sistema. Pero tal vez les incite a los pacientes a una selection segun los riesgos. [fre] Les réformes du service national de santé britannique : la fin d'un mythe ? . Le service de santé britannique est souvent opposé aux systèmes qualifiés d'assurantiels, telle que la Sécurité sociale en France où le prestataire qui soigne et l'assureur qui rembourse sont deux entités séparées. Financé presque exclusivement par l'impôt, cette distinction est sans objet dans le système britannique. . Cependant, ce service de santé rencontre les mêmes problèmes de régulation de la dépense et d'efficacité que les autres systèmes. Dans ce contexte, les réformes entrepri. ses dans les années quatre-vingt-dix visaient à la mise en place d'un quasi-marché dans un dispositif jusqu'alors très centralisé : rétablissement d'une certaine séparation entre acheteurs et fournisseurs de services de santé ; rôle et responsabilité accrus du généraliste. . À plus long terme, cette responsabilisation devrait contribuer à une plus grande efficacité du système. Mais cela n'exposera-t-il pas alors les patients à une sélection en fonction de leurs risques ? [eng] The British National Health Service Reforms: The End of a Legend? . The British health service is often compared with insurance-based systems such as the social security system in France, where the provider of treatment and the reimbursing insurer are two separate entities. This distinction does not apply to the British system, which is financed virtually entirely by taxes. . However, the British health service has the same efficiency and expenditure regulation problems as the other systems. Reforms were consequently undertaken in the 1990s to set up a quasi-market in a hitherto highly centralized system. Buyers and suppliers of health services were separated to some extent and GPs were given a greater role and responsibility. . Over the longer term, making GPs more responsible for their work should help make the system more efficient. Yet would this expose the patients to a risk-based selection? [ger] Die Reform des staatlichen Gesundheitsdienstes in GroBbritannien: das Ende eines Mythos . Der staatliche Gesundheitsdienst GroBbritanniens wird oftmals den Systemen gegeniibergestellt, die auf dem Versicherungsprinzip basieren, wie beispielsweise der Sozialversicherung in Frankreich, wo der Erbringer von Gesundheitsdiensten und der Versicherer, der die Kosten erstattet, zwei verschiedene Einheiten darstellen. Beim britischen Gesundheitsdienst, der ausschlieBlich aus Steuermitteln finanziert wird, ist eine solche Unter- scheidung bedeutungslos. . Hinsichtlich der Kostendâmpfung und der Effizienz kennt dieser Gesundheitsdienst jedoch die gleichen Problème wie die anderen Système. Vor diesem Hintergrund zielten . die in den neunziger Jahren durchgefuhrten Reformen auf die Schaffung eines Quasimarktes in einem System ab, das bis dahin ûberaus zentralisiert war; dadurch sollte erneut eine gewisse Unterscheidung zwischen Kunden und Anbietern von Gesundheitsdiensten eingefuhrt und dem Allgemeinmediziner eine grôBere Rolle und Verantwortung zugewiesen werden. . Lângerfristig wird dièse grôBere Verantwortlichkeit sicherlich zu einer starkeren Effizienz des Systems beitragen. Es stellt sich allerdings die Frage, ob dies nicht eine Selektion der Patienten entsprechend ihren Risiken zur Folge haben wird.

Suggested Citation

  • Jacques Chaperon & Lise Rochaix, 1996. "Les réformes du service national de santé britannique : la fin d'un mythe ?," Économie et Statistique, Programme National Persée, vol. 291(1), pages 87-102.
  • Handle: RePEc:prs:ecstat:estat_0336-1454_1996_num_291_1_6031
    DOI: 10.3406/estat.1996.6031
    Note: DOI:10.3406/estat.1996.6031
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    References listed on IDEAS

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    1. Brenda Leese & Caroline Taylor & Nick Bosanquet, 1995. "A stitch in time? Minor surgery in general practice," Working Papers 132chedp, Centre for Health Economics, University of York.
    2. Carol Propper, 1995. "Regulatory reform of the NHS internal market," Health Economics, John Wiley & Sons, Ltd., vol. 4(2), pages 77-83, March.
    3. Brenda Leese & Mike Drummond & Roger Hawkes, 1994. "Medical technology in general practice in the UK: will fundholding make a difference?," Working Papers 122chedp, Centre for Health Economics, University of York.
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    1. Bruno Ventelou, 1999. "Les dépenses de santé des Français : une maladie d'amour?," Revue de l'OFCE, Programme National Persée, vol. 71(1), pages 247-280.
    2. Maryse Gadreau & Claude Schneider-Bunner, 1997. "L'équité dans le modèle de "concurrence organisée" pour la régulation d'un système de santé," Économie et Prévision, Programme National Persée, vol. 129(3), pages 221-237.

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