Changing Healthcare System Types

Abstract

This article classifies 32 Organisation for Economic Co‐operation and Development (OECD) healthcare systems based on data from 2001 and 2007. It shows that European countries are clustered in different types of healthcare systems and that traditional typologies are only partially represented in the four types of healthcare systems identified in this study. Type 1 represents countries with low total health expenditure (THE), high public financing, and low out‐of‐pocket payment (OOP). In‐patient healthcare is higher and out‐patient healthcare lower than the OECD average. General practitioners (GPs) are paid by capitation, and patients' access to healthcare is strictly regulated. Type 2 represents countries with an average level of THE, high public financing, above‐average OOP, and high in‐patient and out‐patient healthcare. GPs receive a salary, and access regulation is strict. Type 3 is characterized by very low THE, low public financing, and very high OOP. Both in‐patient and out‐patient healthcare is well below average, and GPs are paid a salary. Type 4 includes systems with the highest THE, the highest public financing, and the lowest direct payments by patients. In‐patient healthcare is below the OECD mean and out‐patient healthcare is well above it. GPs are paid by fee‐for‐service, and most countries offer free choice of medical doctors. The clusters for the years 2001 and 2007 are quite robust. During this time period, THE increased, and patients' access to medical doctors has since become more regulated.

Exploring the differences in general practitioner and health care specialist utilization according to education, occupation, income and social networks across Europe: findings from the European social survey (2014) special module on the social determinants of health

“…It should be noted, however, that our study showed that Portugal, which has the lowest total health expenditure among our countries 22 , actually had the largest educational inequalities in specialist use. Portugal also has a relatively high level of private out of pocket (OOP) payments 23 .…”

“…This is likely to affect the actual use of such services; for example, a fee-for-service payment may set an incentive for doctors to see their patients often, while payment per capita or a fixed salary may give an incentive to reduce the number of patient visits 23 24 . A second dimension relates to whether patients have free access to GPs or whether they have to sign onto a GP's list for a longer period, which is referred to as 'gatekeeping' 23 . Patients may also have varying options in different countries when consulting a specialist.…”

The Efficiency of Post‐Communist Countries’ Health Systems

“…On the other hand, the percentage of out-of-pocket patient payments or private insurance allows for the assessment of the inancial burden imposed on households in the event of necessity to use health services [7]. The high level of out-of-pocket expenses increases the diiculty of obtaining medical assistance for people with lower incomes and lower health status [8]. The countries with a low share of public expenditure should aim at reducing the level of out-of-pocket payments in favour of prepaid private insurance.…”

Wpływ struktury finansowania na wyniki funkcjonowania systemów opieki zdrowotnej w krajach Unii Europejskiej / The impact of financing structure on the healthcare systems outcomes in the European Union countries

“…Natomiast udział płatności ze środków własnych pacjentów jest wykorzystywany do oceny obciążenia finansowego nakładanego na indywidualnych pacjentów. Wyższe wydatki prywatne zwiększają trudności w uzyskaniu dostępu do niezbędnej opieki zdrowotnej dla osób o niższych dochodach i gorszym stanie zdrowia [Wendt 2014]. …”

“…Przykładem takiej analizy [Wendt 2014] jest sklasyfikowanie systemów opieki zdrowotnej krajów OECD na podstawie wskaźników struktury finansowania (poziomu wydatków całkowitych, udziału finansowania ze środków publicznych i środków własnych pacjenta), struktury pacjentów (udziału pacjentów hospitalizowanychin-patient i leczonych ambulatoryjnie -out-patient) oraz sposobu wynagradzania lekarzy pierwszego kontaktu i swobody pacjenta w uzyskaniu specjalistycznej pomocy lekarskiej.…”