The problems within the health care systems of western European countries, and their current attempts at reform, can be analyzed by comparing those countries having national health service (NHS) systems with those having social security systems. There are important differences in the structures, processes, and outcomes of these two types of health care systems, and thus in the problems they face. Greater cost control, equity, and, possibly, efficiency in improving the population's health are the advantages of NHS systems; however, public satisfaction is lower than in social security systems. Attempts to overcome this trade-off between the outcomes of the two types of health care systems are the main goal of the reforms. To achieve this goal, there has been a trend toward convergence of NHS and social security systems. For the NHS systems of Latin-rim countries, however, which have received less political commitment and public support than those elsewhere, this means a return to the former social security systems—a trend that may reintroduce the problems associated with these types of systems but without any evidence that public satisfaction will increase.
Get full access to this article
View all access options for this article.
References
1.
Organization for Economic Cooperation and Development. The Reform of Health Care: A Comparative Analysis of Seven OECD Countries. Paris, 1992.
2.
Organization for Economic Cooperation and Development. The Reform of Health Care Systems: A Review of Seventeen OECD Countries. Paris, 1994.
3.
Abel-SmithB.MossialosE.Cost containment and health care reform: A study of the European Union. Health Policy28: 89–132, 1994.
4.
RoemerM. I.Health care departments and medical care—World scanning. Am. J. Public Health50: 154–160, 1960.
5.
Commission of the European Communities. Social Protection in Europe. Luxembourg, 1993.
6.
Esping-AndersonG.The Three Worlds of the Welfare Capitalism. Polity Press, New York, 1990.
7.
GoughI.Economic institutions and the satisfaction of human needs. J. Econ. Stud.27: 25–66, 1994.
8.
KorpiW.The Democratic Class Struggle. Routledge & Kegan Paul, London, 1983.
9.
BaldwinP.The Politics of Social Solidarity: Class Bases of the European Welfare State, 1875–1975. Cambridge University Press, Cambridge, England, 1990.
10.
NavarroV.Why some countries have national health insurance, others have national health services, and the United States has neither. Int. J. Health Serv. 19: 383–404, 1989.
11.
DoyalL.GoughI.A Theory of Human Need. The Guildford Press, New York, 1991.
12.
PereiraJ.PintoC. G.Portugal. In Equity in the Finance and Delivery of Health Care: An International Perspective, edited by Van DoorsalerE.WagstaffA.RuttenF., pp. 181–200. Oxford Medical Publishers, New York, 1993.
13.
ReisV. P.CarvalhoR.Portugal. In The Reform of Health Care Systems: A Review of Seventeen OECD Countries, pp. 251–263. OECD, Paris, 1994.
14.
KryiopoulosJ. E.TsalikisG.Public and private imperatives of Greek health policies. Health Policy26: 105–117, 1993.
15.
FerreiraM.The rise and fall of democratic universalism: Health care reform in Italy, 1978–1994. J. Health Polit. Policy Law20: 276–302, 1995.
16.
NavarroV.ElolaJ.Análisis de las políticas sanitarias españolas, 1975–1992. Sistema126: 19–39, 1995.
17.
Van DoorsalerE.WagstaffA.Equity in the finance and delivery of health care: Methods and findings. In Equity in the Finance and Delivery of Health Care: An International Perspective, edited by Van DoorsalerE.WagstaffA.RuttenF., pp. 20–48. Oxford Medical Publishers, New York, 1993.
18.
WagstaffA.DoorsalerE.Equity in the finance and delivery of health care: Concepts and definitions. In Equity in the Finance and Delivery of Health Care: An International Perspective, edited by Van DoorsalerE.WagstaffA.RuttenF., pp. 7–19. Oxford Medical Publishers, New York, 1993.
19.
GervásJ.PérezM.StarfieldB.Primary care, financing, and gatekeeping in western Europe. Fam. Pract.11: 307–317, 1994.
20.
ElolaJ.SunyerJ.NietoJ.Infant mortality and health care organization in western European countries. Submitted for publication.
21.
Organization for Economic Cooperation and Development. OECD Health Systems: Facts and Trends, 1960–1991. Paris, 1993.
22.
BattistaR. N.Lessons from the eight countries. Health Policy30: 397–421, 1994.
23.
HorowitzM. M.AppelbaumF. R.ChesonB. D.Availability and appropriateness of allogenic bone marrow transplantation for chronic myeloid leukemia in 10 countries. N. Engl. J. Med.331: 1063–1067, 1994.
24.
MatesanzR.MirandaB.FelipeC.Organ procurement and transplantation in Spain. The impact of transplant coordination. Spanish National Transplant Organization (ONT). Nephrol. Dial. Transplant.9: 475–478, 1994.
25.
ElolaJ.DaponteA.NavarroV.Health and the organization of the health care system in western European countries. Am. J. Public Health85: 1397–1405, 1995.
26.
BlendonR. J.Satisfaction with health system in ten nations. Health Aff. 9: 185–192, 1990.
27.
BlendonR. J.Spain's citizens assess their health care system. Health Aff. 10: 216–228, 1991.
28.
SchneiderM.Evaluation of cost-containment acts in Germany. In Health Quality and Choice, pp. 63–81. OECD, Paris, 1994.
29.
Organization for Economic Cooperation and Development. Reform of the health care system in the Netherlands. In The Reform of Health Care: A Comparative Analysis of Seven OECD Countries, pp. 87–101. OECD, Paris, 1992.
30.
Office Fédéral des Assurances Sociales. Switzerland. In The Reform of Health Care Systems: A Review of Seventeen OECD Countries, pp. 285–302. OECD, Paris, 1994.
31.
Organization for Economic Cooperation and Development. The reform of the health system in France. In The Reform of Health Care: A Comparative Analysis of Seven OECD Countries, pp. 45–55. Paris, 1992.
32.
Abel-SmithB.Who is the man out?: The experience of western Europe in containing costs of health care. Milbank Q. 63: 1–17, 1985.
33.
SmithB. AbelCost containment and new priorities in the European Community. Milbank Q. 70: 393–416, 1992.
34.
EvansR. G.Public health insurance: The collective purchase of individual care. Health Policy7: 175–188, 1987.
35.
GoldbergM. A.MarmorT. R.WhiteJ.The relation between universal health insurance and cost control. N. Engl. J. Med.332: 742–744, 1995.
36.
Abel-SmithB.L'experience de douze pays européens en matière du contrôle du coût des soins de santé (1977–1983). CCE, Luxembourg, 1984.
37.
Ministry of Welfare, Health and Community Affairs. Willingness to Change. Rijswick, 1988.
38.
Minister of Social Affairs. Social Welfare in Transition: A Presentation of Swedish Welfare Policies. Stockholm, 1994.
39.
Working for Patients. HMSO, London, 1989.
40.
GlennersterH.MatsaganisM.The English and Swedish health care reforms. Int. J. Health Serv. 24: 231–251, 1994.
41.
StewartJ.WalshK.Changes in the management of public services. Public Admin. 70: 499–518, 1992.
42.
SaltmanR.Patient choice and patient empowerment in northern European health systems: A conceptual framework. Int. J. Health Serv. 24: 201–229, 1994.
43.
HarrisonB.Mean and Lean: The Changing Landscape of Corporate Power in the Age of Flexibility. Basic Books, New York, 1994.
44.
GlennersterH.Le GrandJ.The development of quasi-markets in welfare provision in the United Kingdom. Int. J. Health Serv. 25: 203–218, 1995.
45.
FierlbeckK.Marketing care: The politicization of health care in the United Kingdom. Stud. Polit. Econ.45: 100–128, 1994.
46.
GustafssonR. Å.Open the black box: Paradoxes and lacunas in Swedish health care reforms. Int. J. Health Serv. 25: 243–258, 1995.
47.
WileyM. M.Quality of care and the reform agenda in the acute hospital sector. In Health: Quality and Choice, pp. 27–44. Paris, 1994.
48.
Ministry of Health. Denmark. In The Reform of Health Care Systems: A Review of Seventeen OECD Countries, pp. 123–131. OECD, Paris, 1994.
49.
Swedish Planning and Rationalization Institute. Sweden. In The Reform of Health Care Systems: A Review of Seventeen OECD Countries, pp. 265–284. OECD, Paris, 1994.
50.
Di BiaseR.CatoniG.Italy. In The Reform of Health Care Systems: A Review of Seventeen OECD Countries, pp. 181–204. OECD, Paris, 1994.
51.
Comisión para el Análisis y Evaluación del Sistema Nacional de Salud. Informe y Recomendaciones. Ministerio de Sanidad y Consumo, Madrid, 1991.
52.
SisourasA.KasokisA.MosialosE.Greece. In The Reform of Health Care Systems: A Review of Seventeen OECD Countries, pp. 149–165. OECD, Paris, 1994.
53.
Organization of Economic Cooperation and Development. Spain. In The Reform of Health Care: A Comparative Analysis of Seven OECD Countries, pp. 103–112. Paris, 1992.
54.
WagnerR.Luxembourg. In The Reform of Health Care Systems: A Review of Seventeen OECD Countries, pp. 219–226. OECD, Paris, 1994.
55.
BachS.Managing a pluralist health system: The case of health care reform in France. Int. J. Health Serv. 24: 593–606, 1994.
56.
HenkeK.-O.MurrayM. D.AdeC.Global budgeting in Germany, lessons for the United States. Health Aff. 13: 7–21, 1994.
