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Are Health Problems Systemic? Politics of Access and Choice under Beveridge and Bismarck Systems

Author

Listed:
  • Zeynep Or

    (IRDES Institute for research and information in health economics)

  • Chantal Cases

    (IRDES Institute for research and information in health economics)

  • Melanie Lisac

    (Bertelsmann Stiftung)

  • Karsten Vrangbaek

    (University of Copenhagen)

  • Ulrika Winblad

    (Department of Public Health and Caring Sciences Uppsala Univeristy)

  • Gwyn Bevan

    (London School of Economics)

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. 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 health care 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.

Suggested Citation

  • Zeynep Or & Chantal Cases & Melanie Lisac & Karsten Vrangbaek & Ulrika Winblad & Gwyn Bevan, 2009. "Are Health Problems Systemic? Politics of Access and Choice under Beveridge and Bismarck Systems," Working Papers DT27, IRDES institut for research and information in health economics, revised Sep 2009.
    • Handle: RePEc:irh:wpaper:dt27
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    References listed on IDEAS

    as
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    Cited by:

    1. Aysun Aygün, 2021. "Are family medicine centres achieving their target in Turkey: Impact on health care utilization of mothers and infants," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(1), pages 189-208, January.
    2. Thierry Debrand & Nicolas Sirven, 2009. "What are the Motivations of Pathways to Retirement in Europe: Individual, Familial, Professional Situation or Social Protection Systems?," Working Papers DT28, IRDES institut for research and information in health economics, revised Oct 2009.
    3. Catherine Pollak, 2012. "Employed and Happy despite Weak Health? Labour Market Participation and Job Quality of Older Workers with Disabilities," Working Papers DT45, IRDES institut for research and information in health economics, revised Mar 2012.
    4. Göpffarth, Dirk & Henke, Klaus-Dirk, 2013. "The German Central Health Fund—Recent developments in health care financing in Germany," Health Policy, Elsevier, vol. 109(3), pages 246-252.
    5. McKay, Madeleine & Lavergne, M. Ruth & Lea, Amanda Prince & Le, Michael & Grudniewicz, Agnes & Blackie, Doug & Goldsmith, Laurie J. & Marshall, Emily Gard & Mathews, Maria & McCracken, Rita & McGrail,, 2022. "Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan," Health Policy, Elsevier, vol. 126(6), pages 565-575.
    6. Ongaro, Edoardo & Ferré, Francesca & Fattore, Giovanni, 2015. "The fiscal crisis in the health sector: Patterns of cutback management across Europe," Health Policy, Elsevier, vol. 119(7), pages 954-963.
    7. Christine André & Philippe Batifoulier & Mariana Jansen-Ferreira, 2016. "Privatisation de la santé en Europe. Un outil de classification des réformes," Working Papers hal-01256505, HAL.
    8. André, Christine, 2015. "Les systèmes de santé européens en longue période," Revue de la Régulation - Capitalisme, institutions, pouvoirs, Association Recherche et Régulation, vol. 17.
    9. Zigante, Valentina, 2011. "Assessing welfare effects of the European Choice Agenda: the case of health care in the United Kingdom," LSE Research Online Documents on Economics 53449, London School of Economics and Political Science, LSE Library.
    10. Thierry Debrand & Christine Sorasith, 2010. "Out-of-Pocket Maximum Rules under a Compulsatory Health Care Insurance Scheme: A Choice between Equality and Equity," Working Papers DT34, IRDES institut for research and information in health economics, revised Nov 2010.
    11. Nicolas Sirven & Brigitte Santos-Eggimann & Jacques Spagnoli, 2012. "Comparability of Health Care Responsiveness in Europe," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 105(2), pages 255-271, January.
    12. Aida Isabel Tavares & Inês Marques, 2021. "Multi-layer health insurance coverage, medical services use and health in a Universal National Health System, the case of Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(1), pages 141-153, February.
    13. Or, Zeynep & Cases, Chantal & Lisac, Melanie & Vrangbæk, Karsten & Winblad, Ulrika & Bevan, Gwyn, 2010. "Are health problems systemic? Politics of access and choice under Beveridge and Bismarck systems," Health Economics, Policy and Law, Cambridge University Press, vol. 5(3), pages 269-293, July.
    14. Thierry Debrand & Christine Sorasith, 2010. "Bouclier sanitaire : choisir entre égalité et équité ? Une analyse à partir du modèle ARAMMIS," Working Papers DT32, IRDES institut for research and information in health economics, revised Jun 2010.
    15. Sergey Shishkin & Alexandra Burdyak & Elena Potapchik, 2013. "Patient choice in the post-Semashko health care system," HSE Working papers WP BRP 09/PA/2013, National Research University Higher School of Economics.
    16. Helene Barroy & Zeynep Or & Ankit Kumar & David Bernstein, 2014. "Sustaining Universal Health Coverage in France: A Perpetual Challenge," Health, Nutrition and Population (HNP) Discussion Paper Series 91323, The World Bank.
    17. Tenbensel, Tim & Eagle, Samantha & Ashton, Toni, 2012. "Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity," Health Policy, Elsevier, vol. 106(1), pages 29-36.
    18. Groenewegen, Peter P. & Dourgnon, Paul & Greß, Stefan & Jurgutis, Arnoldas & Willems, Sara, 2013. "Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries," Health Policy, Elsevier, vol. 113(1), pages 170-179.
    19. Vengberg, Sofie & Fredriksson, Mio & Winblad, Ulrika, 2019. "Patient choice and provider competition – Quality enhancing drivers in primary care?," Social Science & Medicine, Elsevier, vol. 226(C), pages 217-224.
    20. Joan Costa-Font & Valentina Zigante, 2016. "The choice agenda in European health systems: the role of middle-class demands," Public Money & Management, Taylor & Francis Journals, vol. 36(6), pages 409-416, September.
    21. Or, Zeynep & Penneau, Anne, 2018. "A Multilevel Analysis of the determinants of emergency care visits by the elderly in France," Health Policy, Elsevier, vol. 122(8), pages 908-914.
    22. Joan Costa-i-Font & Valentina Zigante, 2014. "The Choice Agenda' in European Health Systems: The Role of 'Middle Class Demands," LEQS – LSE 'Europe in Question' Discussion Paper Series 82, European Institute, LSE.
    23. repec:hal:cepnwp:hal-01256505 is not listed on IDEAS
    24. Aleksandra Torbica & Rosanna Tarricone & Michael Drummond, 2018. "Does the approach to economic evaluation in health care depend on culture, values, and institutional context?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(6), pages 769-774, July.
    25. Grazyna Kozun-Cieslak & Pavel Zdrazil, 2021. "Efficiency of Healthcare Systems in the European Union States – Who Performs Better – Bismarckians or Beveridgeans?," European Research Studies Journal, European Research Studies Journal, vol. 0(Special 4), pages 397-411.

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    More about this item

    Keywords

    Health system; Beveridge; Bismarck; reforms; performance;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O57 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Comparative Studies of Countries

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