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Health Care Reform Controlling Spending and Increasing Efficiency

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  • Howard Oxley
  • Maitland MacFarlan

Abstract

The paper reviews trends in health-care expenditure and assesses the main forces underlying the increase since 1960. It then describes and evaluates various health-care reforms. The report argues that top-down budget controls appear to have had some success in reducing the growth in health-care spending but, to be sustainable, they need to be supported by microeconomic reforms. Significant improvements in micro-efficiency and effectiveness can be obtained by improving incentives facing health-care providers. Policy developments in a few leading countries suggest that a system where funders/insurers act as purchasers, contracting with competing health-care providers, is a promising model for reform. A statistical annex assesses whether differences in institutional arrangements for funding and providing health care explain international differences in health expenditure ... Ce document porte sur l’évolution des dépenses de santé et les facteurs qui expliquent leur croissance depuis 1960. Il décrit ensuite et évalue diverses réformes des systèmes de santé. Il en conclut que les plafonnements budgétaires semblent avoir eu un impact sur la réduction de la croissance des dépenses de santé, mais pour que cette réduction soit durable ces contrôles doivent s’accompagner de réformes micro-économiques. Des améliorations sensibles de l’efficience au niveau micro-économique et de l’efficacité peuvent être obtenues grâce à une incitation accrue auprès des fournisseurs de soins de santé. L’évolution observée dans quelques pays où les réformes sont le plus avancées permet de penser qu’un système où les bailleurs de fonds/assureurs agissent en tant qu’acheteurs et passent des contrats avec des prestataires de soins de santé mis en concurrence constitue un modèle de réforme prometteur. Dans l’annexe, une analyse économétrique étudie si les différences dans les systèmes institutionnels de financement et de fourniture de soins de santé peuvent expliquer les différences constatées au niveau international dans les dépenses de santé.

Suggested Citation

  • Howard Oxley & Maitland MacFarlan, 1994. "Health Care Reform Controlling Spending and Increasing Efficiency," OECD Economics Department Working Papers 149, OECD Publishing.
  • Handle: RePEc:oec:ecoaaa:149-en
    DOI: 10.1787/338757855057
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    Cited by:

    1. V. N. Ivanov & A. V. Suvorov, 2021. "Modern Development Problems of Russian Healthcare (Part 1)," Studies on Russian Economic Development, Springer, vol. 32(6), pages 631-639, November.
    2. Jaume Puig-Junoy, 1998. "Measuring health production performance in the OECD," Applied Economics Letters, Taylor & Francis Journals, vol. 5(4), pages 255-259.
    3. Kieran Mc Morrow & Werner Röger, 2003. "Economic and financial market consequences of ageing populations," European Economy - Economic Papers 2008 - 2015 182, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    4. Abdullah M. Alsabah & Hassan Haghparast-Bidgoli & Jolene Skordis, 2020. "Measuring the Efficiency of Public Hospitals in Kuwait: A Two-Stage Data Envelopment Analysis and a Qualitative Survey Study," Global Journal of Health Science, Canadian Center of Science and Education, vol. 12(3), pages 121-121, March.
    5. Johansson, Per-Olov, 2000. "Properties of actuarially fair and pay-as-you-go health insurance schemes for the elderly. An OLG model approach," Journal of Health Economics, Elsevier, vol. 19(4), pages 477-498, July.
    6. Iga Rudawska, 2005. "Partycypacja pacjentów w kosztach usług zdrowotnych," Gospodarka Narodowa. The Polish Journal of Economics, Warsaw School of Economics, issue 10, pages 39-52.
    7. repec:bla:annpce:v:67:y:1996:i:3:p:463-490 is not listed on IDEAS
    8. Christine André & Philippe Batifoulier & Mariana Jansen-Ferreira, 2016. "Privatisation de la santé en Europe. Un outil de classification des réformes," CEPN Working Papers hal-01256505, HAL.
    9. Anindya Sen, 2005. "Is Health Care a Luxury? New Evidence from OECD Data," International Journal of Health Economics and Management, Springer, vol. 5(2), pages 147-164, June.
    10. repec:bla:glopol:v:8:y:2017:i:s2:p:7-22 is not listed on IDEAS
    11. Panos Kanavos & Olivier Wouters & Aris Angelis & David Tordrup & Panos Kanavos, 2017. "Is the Funding of Public National Health Systems Sustainable over the Long Term? Evidence from Eight OECD Countries," Global Policy, London School of Economics and Political Science, vol. 8, pages 7-22, March.
    12. 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.
    13. Fernández Montt, René, 2008. "Incidencia del Auge en la salud privada [AUGE`s impact in private health]," MPRA Paper 22728, University Library of Munich, Germany.

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