Health Reforms Across the World

The following section is included:

• Contents

What is this book about?

This book presents a diagnosis of the health reforms in 12 small- and mid-sized nations. The countries span the globe, hailing from Africa, Latin America, Asia, Oceania and the Middle East, to Eastern and Western Europe. The study seeks to contribute to cross-national policy learning based on structured multi-country research…

This regional section discusses the health reforms of two sub-Saharan nations: Ghana and Tanzania, located respectively on the west and east coasts of the continent. The section also contains maps that present some core data on population, income level, health spending and health status of the populations. Those data are based on the Appendix of this volume…

The following section is included:

• Introduction
• Brief Profile of Ghana
• Key Features of Ghana’s Health System
• Financing Healthcare in Ghana
• Provision of Healthcare Services
• Healthcare and Health Insurance Administration
• Historical Developments of Ghana’s Healthcare—From Independence to 1985
• From Full Government Financing to “Cash and Carry”
• Historical Developments from 1985 to the Adoption of the NHI in 2003
• Response by Non-Government Actors
• NHI Policy Development
• Political Developments of the NHI
• The Adoption of the NHI in 2003
• Implementation of the NHI—Challenges and Further Developments
• Conclusion
• References

The following section is included:

• Introduction
• Healthcare and Health Financing in Tanzania, 2018
• Tanzania’s Health Policy-Making in the Millennium Development Goals Era
• Health Policy in the Sustainable Development Goals Era
• Summary
• References

Some of the world’s most dramatic political transformations in the late 20^th century took place with the ‘bloodless revolutions’ of Latin American nations shedding their military dictatorships. None of those bloodless revolutions were simple or without conflict, but they ultimately resulted in relatively stable democracies across the continent. Periods of high economic growth, well-educated elites strongly in favor of establishing democratic governance and earlier traditions of civic society organizations (e.g., labor unions supporting social health insurance) were factors that contributed to relative stability. While periods of high economic growth alternated with stagnation (and populist, if democratically elected, leaders often turned more autocratic over time), Latin American countries generally succeeded in improving incomes, education levels and the health of their populations…

The following section is included:

• Introduction
• Major Changes in Chile’s Health Financing in the 20^th Century
• Health of Chile’s Population
• Healthcare and Health Financing in Chile, 2018
• Administration of Healthcare in Chile, 2018
• Conclusions
• References

The following section is included:

• Introduction
• Pressures for Change: Economic and Social Factors and Health Reform Directions
• Ecuador’s Healthcare Services, 2018
• Healthcare Financing in Ecuador, 2018
• Stewardship of Ecuador’s Healthcare
• Decentralization and De-concentration of Health Administration
• Strengthening the National Health Authority
• Reorganizing the Health Ministry
• Outcome of the Correa Reforms
• Conclusion
• Agenda for the Future: Remaining Challenges
• References

Responding to fiscal and budgetary pressures and rising demand for healthcare services since the mid-1970s, governments across Western Europe sought to rein in public spending with a mix of old mechanisms (e.g., general budgets, price and volume controls) and new techniques (financial incentives for patients, insured and healthcare providers, in addition to the delisting of entitlements). The reality of retrenchment turned out to be far less substantial than the rhetoric that accompanied reform efforts, however. In most cases, public health spending expanded to cover new population groups, treatment for new diseases, such as HIV/AIDS, and expensive new medical technology and drugs…

The following section is included:

• Introduction
• Health Insurance in the Netherlands, 2017
• Dutch Healthcare, Health Insurance and Health Administration in the 20^th Century
• Origins and Shape of Market-Oriented Healthcare Reforms in Holland
• Governance of Dutch Healthcare: From Neo-Corporatism to Market to Neo-Neo-Corporatism?
• Changing Positions of Dutch Health Insurers
• Changing Positions of Dutch Healthcare Providers
• New Roles for Patients and Consumers in Dutch Healthcare
• Summary and Conclusions: Results of the 2006 Healthcare Reforms 10 Years Later; Outlook for the Future
• References

The following section is included:

• Introduction
• Health and Healthcare Performance in Switzerland
• Effectiveness
• Equity
• Efficiency
• Responsiveness
• Recent Healthcare Reforms in Switzerland
• The Rich and Tiresome Workings of Swiss Federalism and Direct Democracy
• Reforms in the Insurance Market
• Reforms in Healthcare Provision
• Other Public Health Policies
• Challenges in the Current Swiss Health System
• Lack of Service Coordination and Integration of Care
• Health Expenditure
• Subsidized Premiums for the Middle Class
• Control of Demand and Appropriateness
• Health Promotion and Prevention
• Conclusions
• References

The healthcare systems of Eastern Europe share the legacy of decades-long central state control from the mid-20^th century. The systems reflected the principles of universal coverage, income-related payment and a particular emphasis on mother and child care resulting in low infant and maternal mortality rates. At the same time, fiscal and budget pressures had led to underfunded public facilities, low pay for health professionals, widespread dissatisfaction and unofficial payments across the systems…

The following section is included:

• Introduction
• The Czech Healthcare System, 2018
• Origins and Evolution of Czech Health Financing
• Outcomes of the Czech Health Insurance Reforms
• Healthcare and Health Policy in the Czech Republic, 2000–2018
• Czech Health Policy and the Influence of the EU
• Conclusion
• References

The following section is included:

• Historical Development
• Health Insurance and Healthcare in Slovenia, 2018
• Healthcare Governance: Federal and Local Levels of Government and Other Stakeholders
• Economic Crisis and Public Finance: Consequences for Health Financing
• Austerity Measures and Health Reforms
• Slovenia’s Unfinished Health Reform Agenda: Governance, Finance and Other Issues
• Conclusion
• References
• Appendix

The following section is included:

• Historical Background
• Forces Leading to Reform
• Israel’s Healthcare System, 2018
• The Continuing Evolution of the 1995 Health Insurance Reform: From Big Bang to Incrementalism?
• The Shift to Incrementalism
• Theoretical Implications of the Israeli Case: The Role of the State and the Dominant Cultural Orientation
• References

Asia and Oceania are vast and heterogeneous continents, including the two largest nations of the world, China and India, and many smaller ones, with widely divergent income levels, economic growth rates, levels of health spending and health status of their populations. They also vary in political regimes, administrative capacities and cultural and institutional legacies, and those factors are reflected in the direction and pace of their health reforms…

The following section is included:

• Introduction
• New Zealand’s Healthcare
• Health Reform Waves in New Zealand
• Early 1990s: The Big Bang
• Modifications in the Late 1990s
• A Return to Community Governance and Regional Collaboration in the 2000s
• Structural Stability, Incremental Change and Austerity in the 2010s
• Summary of Policy Reform
• The Drivers of Change
• Efficiency and Quality
• Competition and Choice
• Governance and Voice
• Conclusion
• References

The following section is included:

• Introduction
• Healthcare Financing: A Mixed, Multi-Layered System with Targeted Subsidies for the Elderly and Low-Income Families
• Medisave
• MediShield and MediShield Life
• Medifund
• Eldercare and ElderShield
• Targeted Subsidies and Means Testing
• Healthcare Provision in Singapore
• Primary Care
• Secondary and Tertiary Care
• Traditional Medicine
• Commercialization of Healthcare and Medical Tourism
• Hospital Restructuring
• Clustering of Hospitals
• Context of Healthcare Transformation
• Demographic and Epidemiologic Transitions
• Organizational and Governance Context
• Conclusions
• References

The following section is included:

• Introduction
• History of Taiwan’s NHI
• Planning for the NHI
• Legislation and Implementation
• Modus Operandi of Taiwan’s NHI
• Financing
• Cost Sharing by Patients
• Healthcare Delivery in Taiwan
• Paying Healthcare Providers
• Cost Containment through Global Budgets
• The NHI’s Health Information System
• The Role of the State and Organized Stakeholders in Taiwan’s Health Policy
• Recent Reforms
• Challenges
• Demographic Transition
• The Burden of NCDs
• Quality of Care
• Parallel Private System Evolving
• Workforce Shortages
• Long-Term Care
• Long-Term Financial Sustainability
• Conclusions
• References

This volume presents a description and analysis of the health reform experiences of 12 small and medium-sized nations across the world during the last quarter of the 20^th century and the early decades of the 21^st century. As mentioned in the introduction, the countries vary in population size, ethnic composition, income levels, healthcare arrangements, cultural backgrounds and styles of policy-making. In that sense, the volume represents a “most different system design” under a broad, common analytical approach. Still, the nations have some important elements in common. They share the overall policy goal of providing universal health coverage (UHC)—access to healthcare for all—with financing that protects families against catastrophic costs of medical care. They seek to safeguard the availability of decent healthcare services, at affordable costs and without insurmountable financial barriers. They faced similar challenges: fiscal and budgetary pressures, demographic and epidemiological transitions, changing consumer preferences and changing views on the proper role of the state…

This Appendix presents selected data on the population, area, income level and composition of health spending and the health status of the population for the 12 countries discussed in this volume. As we have argued elsewhere, many international comparative studies are based on such aggregated statistical data (see the Introduction to this volume). While those data illustrate a certain association or statistical correlation between phenomena, they do not directly provide the base for drawing causal inferences. That is why this Appendix serves to illustrate some general patterns across the nations, not as the main source of information or for drawing lessons from our case studies, as we have done in the main text of this volume. The data support seven general conclusions, already familiar to most experts in the domain of public health…

The following sections are included:

• Contributors’ Biographies
• Index