National Health Systems Throughout the World

Roemer, Milton I.

doi:10.1177/0002764293036006003

Cited by 15 publications

(13 citation statements)

References 6 publications

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“…Roemer came up with his typology at the end of the 1980s and as he acknowledges himself, merely takes into account the paradigm of incentives and competition that appeared around the same time (Roemer 1993); as such, this typology represents an opportunity for researchers to work from a blank slate to uncover the effect of market-oriented reforms on post-war health care systems.…”

Section: Back To Basics: Roemer's Typologymentioning

confidence: 99%

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Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

Bourque¹,

Farrah²

2017

gouvernance

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In 1990, Roemer came up with a very influential health system typology. From his vast study, emerged three types of health care systems: nationalized, mandated and entrepreneurial. Health care systems are not static; slow changes and reforms somewhat alter values and goals on which those systems were initially established. It is fair to say, then, that over the last two decades, health care reformers have adopted a market-oriented governance model that blends new public management (NPM) and managed competition reforms in the provision of health care services to transform supply- and demand-side actors into “responsibilized” customers, payers or providers. These transformations beg the question as to whether we are witnessing a radical redefinition of health care systems through the implementation of market-oriented governance. We propose to add the evolution of market-oriented health reforms in five case studies to Milton Roemer’s typology of health systems. In light of our findings, we will wrap up the analysis with an assessment of the usefulness of Roemer’s classification for social scientists to grasp the evolution of health systems over the past 20 years, and more importantly, to analyze the current state of these health care systems after years of market-oriented reforms.En 1990 Milton J. Roemer a proposé une typologie des systèmes de santé qui eut une influence importante. Cette grille d’analyse propose d’étudier les systèmes de santé à partir de trois grands modèles : les systèmes nationalisés, mandatés et entrepreneuriaux. Ceux-ci sont toutefois en constante évolution. Des changements incrémentaux ainsi que des réformes plus importantes influencent les valeurs et les objectifs qui les avaient inspirés lors de leur mise en oeuvre. Ainsi, depuis deux décennies on peut affirmer que les systèmes de santé ont emprunté les valeurs associées à la nouvelle gestion publique ainsi qu’à la gouvernance de marché dans le but de responsabiliser les consommateurs et les producteurs de soins. Ces transformations importantes posent la question de la redéfinition des systèmes de santé. Autrement-dit, sommes-nous témoins de changements radicaux des soins de santé nationaux qui nécessitent une nouvelle grille d’analyse ? Cet article propose une analyse des dernières réformes des systèmes de santé de cinq pays à la lumière de la typologie de Roemer tout en prenant en compte les éléments liés à l’implantation de la nouvelle gestion publique et de la gouvernance de marché qui ont influencé leur évolution. Dans le cadre de cette analyse nous tenterons d’évaluer la pertinence de la typologie de Roemer pour analyser les systèmes de santé actuels et, de façon plus importante, nous analyserons les systèmes après plusieurs années d’imposition de réformes orientées vers le marché

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Section: Back To Basics: Roemer's Typologymentioning

confidence: 99%

“…Governance mechanisms of such systems are dependent on the fact that workers, employers and the state are financing health insurance funds. Lastly, because these funds are historically associated with professions, the management of mandated systems has traditionally been decentralized (Roemer 1993).…”

Section: Back To Basics: Roemer's Typologymentioning

confidence: 99%

Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

Bourque¹,

Farrah²

2017

gouvernance

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“…A demanda por saúde segue um padrão com pequena elasticidade de demanda. Conforme afirma Roemer (1993), autor da lei que possui seu epônimo, a oferta de serviços de saúde consegue por si só gerar a sua própria demanda. Para piorar essa situação, a inflação dos bens e cuidados de saúde é muito mais elevada do que a média de mercado, conforme mostra Rochaix (1990).…”

Section: óTimo De Pareto E Seleção Adversaunclassified

A teoria da agência no setor da saúde: o caso do relacionamento da Agência Nacional de Saúde Suplementar com as operadoras de planos de assistência supletiva no Brasil

Sato

2007

Rev. Adm. Pública

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O relacionamento entre os atores do sistema supletivo de assistência à saúde no Brasil é caracterizado por uma complexa trama de conflitos de interesse e de poder, que podem ser analisados à luz da teoria da agência. Ela emprega elementos da ciência econômica, principalmente das teorias do consumidor e do funcionamento de mercado, conjuntamente com idéias derivadas dos estudos organizacionais e comportamentais, faz uma divisão entre os agentes econômicos em principais e agentes. Analisando o mercado de assistência supletiva, pode-se constatar que ele possui inúmeros atores, que exercem ao mesmo tempo papéis de agentes e principais. É justamente dessa dualidade de papéis que surgem grande parte dos conflitos, e, através de diversos mecanismos de regulação, tenta-se reduzir os custos de agência derivados dos conflitos de interesse que são a causa principal dos problemas de agência dentro desse setor.

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“…This PHC approach has been argued to be effective for the provision and organization of health care services in developing countries (Amonoo et aI., 1984;Newell, 1989). After Mozambique became independent in 1975, the number of health facilities was greatly expanded in all regions, a trend which still continues (Roemer, 1992). The health information system (HIS) of Mozambique has been described as being primarily top-down, implying that while planning and implementation of health systems start at the level of the central Ministry of Health, MISAU 1 , health data are collected at the local community level and sent up to the ministry (Braa et aI., 2001).…”

Section: Health System Organizationmentioning

confidence: 99%

Counter Networks, Communication and Health Information Systems

Mosse

Sahay

2003

Organizational Information Systems in the Context of Globalization

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Abstract:Mozambique, actively trying to deploy ICTs like many developing countries, faces critical problems in providing health care services to its population, especially those living in rural areas. These attempts are extremely complex due to a variety of constraints ranging from inadequate infrastructure to manpower shortages, to a culture that does not yet value the "efficient use of information." In this paper, we unpack the relationship between communication practices and health information flows within the context of th .. primary health care system of Mozambique, and argue that understanding this relationship is crucial for developing context-sensitive approaches to implementing computer-based health infonnation systems. Through an empirical analysis of ongoing efforts in a health district within the Health Information System Program (HISP), we seek to understand the communication practices which surround processes of collection, analysis and transmission of health data up and down the various levels of the health administration hierarchy. The nature of these communication practices has a visible impact on the quality, timeliness and usage of health data. The paper describes the functioning of the health information system as a network comprising multiple human and non-human actors within deep-rooted sociocultural structures. Inspired by Castells, we examine how understanding the reciprocal relationships between communication practices and health information can help to develop "counter networks" to provide hitherto marginalized groups and regions in the potential access to "network society."

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National Health Systems Throughout the World

Cited by 15 publications

References 6 publications

Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

A teoria da agência no setor da saúde: o caso do relacionamento da Agência Nacional de Saúde Suplementar com as operadoras de planos de assistência supletiva no Brasil

Counter Networks, Communication and Health Information Systems

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