Part, Chapter, Paragraph
4001 IV, 11. 1. 3(2) | terminology used to classify health systems (Semashko, Beveridge
4002 IV, 11. 1. 3(2) | important to highlight that health systems are much more complex
4003 IV, 11. 1. 3 | Since the 1970s, spending on health care has grown more quickly
4004 IV, 11. 1. 3 | downward pressure on increasing health expenditures, these cost-containment
4005 IV, 11. 1. 3 | savings (Cutler, 2002). Health reform in the 1990s thus
4006 IV, 11. 1. 3 | In order to measure the health system’s contribution to
4007 IV, 11. 1. 3 | goals in general, and to the health status of citizens in particular,
4008 IV, 11. 1. 3 | ultimately, to support continuous health system improvement efforts –
4009 IV, 11. 1. 3 | assessing the performance of health systems. The concern with
4010 IV, 11. 1. 3 | measuring the performance of health systems dates back to the
4011 IV, 11. 1. 3 | sources to measure and improve health system performance been
4012 IV, 11. 1. 3 | the works to achieve the health system objectives and identify
4013 IV, 11. 1. 3 | publication of the World Health Report by the WHO in 2000,
4014 IV, 11. 1. 3 | which yielded a ranking of health systems in 191 countries,
4015 IV, 11. 1. 3 | analyses of the elements of health care systems are conducted
4016 IV, 11. 1. 3 | this regard (e.g. the OECD Health Project 2004, and Smith
4017 IV, 11. 1. 3 | Smith 2002).~ ~The World Health Report does, however, provide
4018 IV, 11. 1. 3 | starting point for measuring health system performance. It outlines
4019 IV, 11. 1. 3 | dimensions of performance: health attainment as measured by
4020 IV, 11. 1. 3 | assess the responsiveness of health systems to the population’
4021 IV, 11. 1. 3 | when evaluating a country’s health system, these indicators
4022 IV, 11. 1. 3 | conducted, relying heavily on health status indicators to measure
4023 IV, 11. 1. 3 | costs and benefits of the health system. Furthermore, a composite
4024 IV, 11. 1. 3 | political scepticism of health professions and institutions
4025 IV, 11. 1. 3 | measurement tools in modern health systems, and the large number
4026 IV, 11. 1. 3 | approach that depends on the health system being assessed, the
4027 IV, 11. 1. 3 | regulation and governance of health care. The remainder of this
4028 IV, 11. 1. 3 | on the objectives of the health system; these include: access
4029 IV, 11. 1. 4 | delivery of high quality health services to their populations.
4030 IV, 11. 1. 4 | Indeed, equitable access to health care, or access based on
4031 IV, 11. 1. 4 | goal of publicly-funded health systems. It is, therefore,
4032 IV, 11. 1. 4 | important to consider not just health system efficiency, but also
4033 IV, 11. 1. 4 | and the distribution of health care use and accessibility
4034 IV, 11. 1. 4 | accessibility or utilization of health services by factors unrelated
4035 IV, 11. 1. 4 | access to care is coverage by health insurance. Universal, or
4036 IV, 11. 1. 4 | comprehensive basket of health services has been achieved
4037 IV, 11. 1. 4 | In much of Europe, many health care services are free at
4038 IV, 11. 1. 4 | Section 11.6 on Financing health care). Organizational factors
4039 IV, 11. 1. 4 | individual’s propensity to seek health care (Gulliford et al 2002).
4040 IV, 11. 1. 4 | where eligibility to receive health care requires participation
4041 IV, 11. 1. 4 | problems appear limited to health systems funded mainly by
4042 IV, 11. 1. 4 | funded mainly by social health insurance, and in particular
4043 IV, 11. 1. 4 | measuring equity in the use of health services tend to show a
4044 IV, 11. 1. 4 | largely publicly funded health system. Specifically, while
4045 IV, 11. 1. 4 | included in the Survey of Health, Ageing and Retirement in
4046 IV, 11. 1. 4 | assumptions stating that that health status is an adequate measure
4047 IV, 11. 1. 4 | is an adequate measure of health care need or that health
4048 IV, 11. 1. 4 | health care need or that health care utilization can approximate
4049 IV, 11. 1. 4 | Indeed, measuring need for health care has been much-debated
4050 IV, 11. 1. 4 | individual to benefit from health care (Culyer and Wagstaff,
4051 IV, 11. 1. 4 | Wagstaff, 1993). Although health status as an indicator of
4052 IV, 11. 1. 4 | importance than the goal of equal health outcomes. Though there is
4053 IV, 11. 1. 4 | access and utilization of health care, the persistent, and
4054 IV, 11. 1. 4 | persistent, and perhaps widening, health inequalities are also evident.
4055 IV, 11. 1. 4 | Ensuring equal access to health care may arguably be one
4056 IV, 11. 1. 4 | arguably be one means to reduce health inequalities. Many countries
4057 IV, 11. 1. 4 | beyond the provision of health care services are more effective (
4058 IV, 11. 1. 4 | also Section 11.4.2 Public Health Services).~ ~
4059 IV, 11. 1. 5 | 11.1.3.3. Quality in health care~ ~After a period of
4060 IV, 11. 1. 5 | Structure refers to a health care provider’s or facility’
4061 IV, 11. 1. 5 | availability of updated health technologies. Process measures
4062 IV, 11. 1. 5 | Outcomes represent changes in health status due to provided or
4063 IV, 11. 1. 5 | registers were developed for health professionals in order to
4064 IV, 11. 1. 5 | 2001 the OECD launched the Health Care Quality Indicator Project
4065 IV, 11. 1. 5 | cardiac care, diabetes, mental health, patient safety and primary
4066 IV, 11. 1. 5 | general criteria: impact on health, policy importance and susceptibility
4067 IV, 11. 1. 5 | susceptibility to influence by the health system (Mattke, Kelley et
4068 IV, 11. 1. 5 | process improvements in health facilities. At European
4069 IV, 11. 1. 5 | Shaw, 2003). In Germany, health insurance funds impose data
4070 IV, 11. 1. 5 | patients who may be skewing health outcome data (Mossialos
4071 IV, 11. 1. 5 | responsiveness within the health system, and overall levels
4072 IV, 11. 1. 5 | on perceived quality of health and social care suggests
4073 IV, 11. 1. 5 | countries among the top half for health and social services. The
4074 IV, 11. 1. 5 | of perceived quality of health and also social services
4075 IV, 11. 1. 5 | followed a Department of Health report, An Organization
4076 IV, 11. 1. 5 | the National Institute of Health and Clinical Excellence (
4077 IV, 11. 1. 5 | resolution urging the World Health Organization to develop
4078 IV, 11. 1. 5 | signs of declining patient health to avoid acute crises. This
4079 IV, 11. 1. 5 | barrier to high quality health care. They have therefore
4080 IV, 11. 1. 5 | arise from poor design of health care delivery processes (
4081 IV, 11. 1. 5 | such as diminished trust in health systems, medical professionals
4082 IV, 11. 1. 5 | expressed confidence in health professionals, a sizeable
4083 IV, 11. 1. 5 | Although patients believe the health system is responsible for
4084 IV, 11. 1. 5 | Satisfaction with the health system~ ~Patient and public
4085 IV, 11. 1. 5 | of satisfaction with the health systems ranked from 0 (least
4086 IV, 11. 1. 5 | with the statement “the health system runs quite well” (
4087 IV, 11. 1. 5 | held a positive view of the health system from 1996-2002. The
4088 IV, 11. 1. 5 | specifically regarding preventive health and lifestyles. When asked
4089 IV, 11. 1. 5 | Overall satisfaction with the health system (scale of 1-8)~ ~
4090 IV, 11. 1. 6 | human service sector such as health. Economic theory presents
4091 IV, 11. 1. 6 | resources committed to the health system e.g. costs and utilization
4092 IV, 11. 1. 6 | or productivity of the health system. Macro level studies
4093 IV, 11. 1. 6 | measures of expenditure and health status; thus they should
4094 IV, 11. 1. 6 | identify associations between health system features or expenditure
4095 IV, 11. 1. 6 | expenditure and outcomes.~ ~Health system productivity can
4096 IV, 11. 1. 6 | developing a measure of health system productivity attempting
4097 IV, 11. 1. 6 | the system (Department of Health, 2005). The quality indicators
4098 IV, 11. 1. 6 | and quality outcomes of health system financing. Specifically,
4099 IV, 11. 1. 6 | quantity of healthcare. In the health service, there are three
4100 IV, 11. 1. 6 | 2004).~ ~Most European health systems have in place a
4101 IV, 11. 1. 6 | the role DRGs play in the health system, and in some cases
4102 IV, 11. 1. 6 | In England the DRG-style Health Related Group (HRG) system
4103 IV, 11. 1. 6 | directly related to improving health. Included in these costs
4104 IV, 11. 1. 6 | country data show that social health insurance countries generally
4105 IV, 11. 1. 6 | see Section 11.6 Financing Health Care). In the Central and
4106 IV, 11. 1. 6 | separation of the collection of health insurance premiums from
4107 IV, 11. 1. 6 | et al, 2004).~ ~Private health insurance (PHI) is associated
4108 IV, 11. 1. 6 | costs than statutory public health insurance systems. This
4109 IV, 11. 1. 6 | lower for the statutory health insurance systems, around
4110 IV, 11. 2 | 11.2. Health service provision~ ~The
4111 IV, 11. 2 | addressed three key aspects of health system performance: access
4112 IV, 11. 2 | preventive care (public health). Recent trends in the provision
4113 IV, 11. 2 | trends in the provision of health services include the shifting
4114 IV, 11. 2 | level of spending on public health and the extent to which
4115 IV, 11. 2 | the extent to which public health programmes are based on
4116 IV, 11. 2. 1 | contact for patients in the health system. This contact may
4117 IV, 11. 2. 1 | populations, and to make health services more accessible
4118 IV, 11. 2. 1 | healthcare and improved health outcomes (Macinko et al,
4119 IV, 11. 2. 1 | when other determinants of health (e.g. GDP and behavioural
4120 IV, 11. 2. 1 | a 10-component scale of health system characteristics such
4121 IV, 11. 2. 1 | those with systems of social health insurance tend to have higher
4122 IV, 11. 2. 1 | among countries with social health insurance systems in Western
4123 IV, 11. 2. 1 | approaches, the provision of health care and approaches taken
4124 IV, 11. 2. 2 | 11.2.2. Public health services~ ~Public health
4125 IV, 11. 2. 2 | health services~ ~Public health can be defined as the art
4126 IV, 11. 2. 2 | prolonging life and promoting health through the organized efforts
4127 IV, 11. 2. 2 | society. It differs from health services in its focus on
4128 IV, 11. 2. 2 | developed national public health strategies, inclusive of
4129 IV, 11. 2. 2 | tackling inequalities in health. Comprehensive policies
4130 IV, 11. 2. 2 | reduce social inequalities in health can be seen in England,
4131 IV, 11. 2. 2 | al 2006). The concept of health strategies has echoes at
4132 IV, 11. 2. 2 | AIDS, drug dependence, health monitoring, injuries, rare diseases
4133 IV, 11. 2. 2 | EU’s multi-annual public health programmes ran from 2003
4134 IV, 11. 2. 2 | the development of public health, enhance the capability
4135 IV, 11. 2. 2 | coordinated fashion to threats to health, and promote health and
4136 IV, 11. 2. 2 | threats to health, and promote health and prevent disease by addressing
4137 IV, 11. 2. 2 | prevent disease by addressing health determinants across all
4138 IV, 11. 2. 2 | European Commission’s Public Health Executive Agency.~ ~No country
4139 IV, 11. 2. 2 | decisions affecting public health, or setting priorities among
4140 IV, 11. 2. 2 | priorities among different public health interventions. One exception
4141 IV, 11. 2. 2 | recent inclusion of public health intervention cost effectiveness
4142 IV, 11. 2. 2 | the National Institute of Health and Clinical Excellence.
4143 IV, 11. 2. 2 | setting priorities in public health typically relate to population
4144 IV, 11. 2. 2 | typically relate to population health status, epidemiological
4145 IV, 11. 2. 2 | 2004).~ ~Spending on public health is extremely difficult to
4146 IV, 11. 2. 2 | Austria (from 1.6% total health spending in 1995 to 2% in
4147 IV, 11. 2. 2 | from 3.5% to 4.7%) (OECD Health data 2007). Very low levels
4148 IV, 11. 2. 2 | most countries, with public health and prevention accounting
4149 IV, 11. 2. 2 | vaccination programmes and public health campaigns on alcohol abuse
4150 IV, 11. 2. 2 | when interpreting public health expenditure data: some public
4151 IV, 11. 2. 2 | expenditure data: some public health programmes may not be accounted
4152 IV, 11. 2. 2 | related to GP practice; public health activities may be coordinated
4153 IV, 11. 2. 2 | particular occupational health programmes, may fall on
4154 IV, 11. 2. 2 | governments have moved mental health problems up on their political
4155 IV, 11. 2. 2 | stigma, discrimination and health threats associated to mental
4156 IV, 11. 2. 2 | However, spending on mental health varies widely across Europe.
4157 IV, 11. 2. 2 | spend at least 10% of their health budget on mental health,
4158 IV, 11. 2. 2 | health budget on mental health, with the lowest levels
4159 IV, 11. 2. 2 | limitation in the area of public health policy in Europe is the
4160 IV, 11. 2. 2 | cost-effectiveness of public health interventions. Commentators
4161 IV, 11. 2. 2 | evaluation in the area of public health, and that the mechanisms
4162 IV, 11. 2. 2 | should be applied to public health to better inform policy
4163 IV, 11. 2. 2 | screening. In terms of mental health, while the evidence base
4164 IV, 11. 2. 2 | the prevalence of mental health disorders.~ ~
4165 IV, 11. 3 | 11.3. Health system resources~ ~Accessible
4166 IV, 11. 3. 1 | 11.3.1. Health workforce~ ~The health sector
4167 IV, 11. 3. 1 | Health workforce~ ~The health sector is highly labour
4168 IV, 11. 3. 1 | intensive. Typically, the health system is among the largest,
4169 IV, 11. 3. 1 | and to train them in rural health issues. Financial incentives
4170 IV, 11. 3. 1 | The role of nurses in the health system varies across Europe.
4171 IV, 11. 3. 1 | completed by a candidate. Health professions’ education in
4172 IV, 11. 3. 1 | management and regulation of health care personnel (Rechel et
4173 IV, 11. 3. 2 | according to the balance between health policy and industrial policy
4174 IV, 11. 3. 2 | governments want to secure health policy objectives in order
4175 IV, 11. 3. 2 | to protect the public’s health, guarantee access to safe
4176 IV, 11. 3. 2 | relatively consistent pattern of health expenditure growth was seen
4177 IV, 11. 3. 2 | drivers of expenditure in the health system. Indeed, as shown
4178 IV, 11. 3. 2 | as a proportion of total health spending has been significant
4179 IV, 11. 3. 2 | outside of the statutory health insurance system. The public
4180 IV, 11. 3. 2 | proportion (%) of total health expenditure, 1990-2005~ ~
4181 IV, 11. 3. 2 | provide excellent data on health status, causes of death
4182 IV, 11. 3. 2 | accordance with the World Health Organization (WHO) priority-list-of-diseases,
4183 IV, 11. 4 | 11.4. Health Technology Assessment~ ~
4184 IV, 11. 4 | research-based innovations provides health care with a multitude of
4185 IV, 11. 4 | to the improvement of the health of European citizens. The
4186 IV, 11. 4 | European citizens. The range of health technologies spans from
4187 IV, 11. 4 | the systems within which health is protected and maintained -
4188 IV, 11. 4 | and maintained - including health informatics - can be seen
4189 IV, 11. 4 | severe obesity.~ ~Effective health technologies do not by themselves
4190 IV, 11. 4 | themselves find their way into health systems through some kind
4191 IV, 11. 4 | implementation of new technologies in health systems: the Health Technology
4192 IV, 11. 4 | technologies in health systems: the Health Technology Assessment.~ ~
4193 IV, 11. 4 | Assessment.~ ~The role of Health Technology Assessment (HTA)
4194 IV, 11. 4 | healthcare policies of given health systems. Technology assessment
4195 IV, 11. 4 | development, diffusion and use of health technology (INAHTA). HTA
4196 IV, 11. 4 | related to the use of a health technology in a systematic,
4197 IV, 11. 4 | formulation of safe, effective, health policies that are patient
4198 IV, 11. 4 | opinion, scientific advice, health statistics and information,
4199 IV, 11. 4 | Technology Assessment in Health Care.~ ~Irrespective of
4200 IV, 11. 4 | professional aspects~· Health services research~· Organisational
4201 IV, 11. 4 | Macroeconomics~· Microeconomics~· Health economic methods such as~·
4202 IV, 11. 4 | and patient preferences in health economic analysis~Information
4203 IV, 11. 4 | other relevant research~· Health information including economic
4204 IV, 11. 4 | funded European Network for Health Technology Assessment, EUnetHTA
4205 IV, 11. 4 | the National Institute for Health and Clinical Excellence (
4206 IV, 11. 4 | Commission and the Council of Health Ministers have stressed
4207 IV, 11. 4 | Commission has expressed that “Health technology assessment is
4208 IV, 11. 4 | collaborate on assessing new health technologies rather than
4209 IV, 11. 4 | agencies, Ministries of health in Member States and the
4210 IV, 11. 5. 1 | related in part to recipient health conditions and in part to
4211 IV, 11. 5. 4 | the characteristics of the health service and the organisational
4212 IV, 11. 5. 4 | improving the knowledge of health professionals and the media
4213 IV, 11. 5. 4 | Member States face greater health problems than the rest of
4214 IV, 11. 5. 4 | means to address them. Their health systems are therefore under
4215 IV, 11. 5. 5 | biomedical science and public health policy. The role of the
4216 IV, 11. 5. 5 | reliable information to the health community in order to raise
4217 IV, 11. 5. 5 | donation rates.~- To train Health Care Professionals from
4218 IV, 11. 5. 5 | for Tissue Banking:(Public Health 2003)~To Develop the method
4219 IV, 11. 5. 5 | Directive.~ ~EUSTITE: (Public Health 2005)~Goals: state-of-the-art
4220 IV, 11. 5. 6 | various policy areas.~· The Health and Consumer Protection
4221 IV, 11. 5. 6 | donors to guarantee the health and safety of the donors.~·
4222 IV, 11. 5. 6 | of European Ministers of Health (Paris, 16-17 November 1987) -
4223 IV, 11. 5. 6 | lists and waiting times in health care (adopted at the 681st
4224 IV, 11. 5. 6 | of medical data~· World Health Organisation Resolution
4225 IV, 11. 6. 1 | 11.6.1. Health expenditure patterns and
4226 IV, 11. 6. 1 | patterns and trends~ ~OECD Health Data (2007) notes that a
4227 IV, 11. 6. 1 | the economy is devoted to health across OECD countries. On
4228 IV, 11. 6. 1 | On average, per capita health spending increased by more
4229 IV, 11. 6. 1 | GDP per capita. In 1970, health spending accounted for just
4230 IV, 11. 6. 1 | than 10% of its income on health.~ ~During the 1970s a combination
4231 IV, 11. 6. 1 | rising at the pace of GDP, health care tends to grow at a
4232 IV, 11. 6. 1 | and Dixon, 2002).~ ~Rising health costs can be seen in all
4233 IV, 11. 6. 1 | spent on healthcare (OECD Health data 2007). And while there
4234 IV, 11. 6. 1 | in controlling growth in health care expenditure but rather
4235 IV, 11. 6. 1 | Switzerland. Per capita health expenditure over the last
4236 IV, 11. 6. 1 | definitions and initial health system characteristics (
4237 IV, 11. 6. 1 | 1999).~ ~Table 11.9. Total health care expenditure as a percentage
4238 IV, 11. 6. 1 | 2004~ ~Table 11.10. Total health care expenditure per capita ($
4239 IV, 11. 6. 2 | Description and assessment of health financing systems~ ~Health
4240 IV, 11. 6. 2 | health financing systems~ ~Health financing consists of three
4241 IV, 11. 6. 2 | pooling and purchasing health services vary across Europe
4242 IV, 11. 6. 2 | on the performance of the health system in terms of equity,
4243 IV, 11. 6. 2 | evaluated on the basis of the health financing goals outlined
4244 IV, 11. 6. 2 | introduced competition between health insurance funds to improve
4245 IV, 11. 6. 2 | mechanisms. The role of private health insurance remains quite
4246 IV, 11. 6. 2 | systems achieve the goals of health financing. Finally, the
4247 IV, 11. 6. 2 | increasingly being guided by formal health technology assessment, with
4248 IV, 11. 6. 2 | mechanisms consisting of private health insurance, medical saving
4249 IV, 11. 6. 2 | play a role in European health systems), cost sharing for
4250 IV, 11. 6. 2 | see below).~ ~European health systems are characterized
4251 IV, 11. 6. 2 | the public share (%) of health expenditure is in most countries
4252 IV, 11. 6. 2 | the public contribution to health spending (e.g. Belgium),
4253 IV, 11. 6. 2 | the large share of private health expenditure in all countries.
4254 IV, 11. 6. 2 | in all countries. Private health insurance (PHI) plays a
4255 IV, 11. 6. 2 | countries where private health insurance was not available
4256 IV, 11. 6. 2 | Germany and Portugal (OECD Health data 2006).~ ~Table 11.11.
4257 IV, 11. 6. 2 | percentage (%) of total health expenditure, 1990-2005~ ~
4258 IV, 11. 6. 2 | near universal) statutory health coverage. The most common
4259 IV, 11. 6. 2 | from taxation to social health insurance contribution mechanisms
4260 IV, 11. 6. 2 | financed through social health insurance (e.g. France,
4261 IV, 11. 6. 2 | reform to the system of health financing was also seen
4262 IV, 11. 6. 2 | and private (substitutive) health insurance to a heavily regulated
4263 IV, 11. 6. 2 | regulated system of statutory health insurance with competing
4264 IV, 11. 6. 2 | and the amount spent on health care; increased accountability
4265 IV, 11. 6. 2 | advantage of separating the health budget from competing national
4266 IV, 11. 6. 2 | trade-offs to be made between health and other sectors at a macro
4267 IV, 11. 6. 2 | prevent integrated public health policies (Mossialos et al,
4268 IV, 11. 6. 2 | on taxation to fund their health systems vary significantly,
4269 IV, 11. 6. 2 | allocations (see section on Social Health Insurance below), which
4270 IV, 11. 6. 2 | populations. Among social health insurance systems, the trend
4271 IV, 11. 6. 2 | Progressivity).~ ~Social health insurance~ ~Social health
4272 IV, 11. 6. 2 | health insurance~ ~Social health insurance provides the organizing
4273 IV, 11. 6. 2 | source because the social health insurance contributions
4274 IV, 11. 6. 2 | the public. Also, social health insurance revenue may be
4275 IV, 11. 6. 2 | Furthermore, if eligibility for health insurance is dependent on
4276 IV, 11. 6. 2 | Romania, or by the individual health insurance funds, as in Austria,
4277 IV, 11. 6. 2 | Mossialos 2008).~ ~Relying on health insurance funds to collect
4278 IV, 11. 6. 2 | introduced to verify the users of health services had paid their
4279 IV, 11. 6. 2 | on total income, making health insurance funds’ revenue
4280 IV, 11. 6. 2 | Mossialos 2008).~ ~The 2006 Health Insurance Law of the Netherlands
4281 IV, 11. 6. 2 | market competition, with health insurers competing on community-rated
4282 IV, 11. 6. 2 | community-rated premiums, type of health plan (reimbursement or benefits
4283 IV, 11. 6. 2 | respects it is a statutory health insurance scheme characterized
4284 IV, 11. 6. 2 | Klazinga, 2007).~ ~Private health insurance~ ~The majority
4285 IV, 11. 6. 2 | mechanisms include private health insurance (PHI) and out-of-pocket
4286 IV, 11. 6. 2 | as a proportion of total health expenditure in almost all
4287 IV, 11. 6. 2 | Ireland and Portugal, private health insurance is partly subsidised
4288 IV, 11. 6. 2 | some extent in all European health systems. The three forms
4289 IV, 11. 6. 2 | discourage excess utilization of health services by creating price
4290 IV, 11. 6. 2 | impact of user charges on health status lowers allocatable
4291 IV, 11. 6. 2 | prescription drugs leads to worse health outcomes, therefore undermining
4292 IV, 11. 6. 2 | as a proportion of total health expenditure, 2004~ ~Informal
4293 IV, 11. 6. 2 | large proportion of total health expenditure in CEE and CIS
4294 IV, 11. 6. 2 | constitute about 30% of total health expenditure in Poland (Lewis,
4295 IV, 11. 6. 2 | Centre for Policies and Health Services revealed that 39%
4296 IV, 11. 6. 2 | respect to the proportion of health service visits incurring
4297 IV, 11. 6. 3 | 1999).~ ~Within social health insurance systems, the degree
4298 IV, 11. 6. 3 | As a result, the social health insurance systems in Germany
4299 IV, 11. 6. 3 | Germany: (1) due to varying health risks, there is considerable
4300 IV, 11. 6. 3 | equalization through social health insurance and negative economic
4301 IV, 11. 6. 3 | contribution mechanisms access to health care depends on the ability
4302 IV, 11. 6. 3 | However, while private health insurance has been found
4303 IV, 11. 6. 3 | individuals to purchase private health insurance, this will make
4304 IV, 11. 6. 3 | the poor. However, private health insurance may also skew
4305 IV, 11. 6. 3 | it can be estimated that health financing in this region
4306 IV, 11. 6. 3 | consumption taxes.~ ~The WHO World Health Report 2000 devised an alternative
4307 IV, 11. 6. 3 | where the ratio of total health contribution to total non-food
4308 IV, 11. 6. 3 | households, regardless of income, health status and utilization;
4309 IV, 11. 6. 4 | some countries with social health insurance funds (Table 11.
4310 IV, 11. 6. 4 | risk selection (in social health insurance systems) and may
4311 IV, 11. 6. 4 | locally or where individual health insurance funds are responsible
4312 IV, 11. 6. 4 | therefore sustainability) in health systems. Thus, the role
4313 IV, 11. 6. 4 | countries with tax-financed health systems (except Cyprus,
4314 IV, 11. 6. 4 | resource collection, e.g. local health authorities or special purchasing
4315 IV, 11. 6. 4 | weakest element in most health systems. Recent years have
4316 IV, 11. 6. 4 | adjustment. However, many health systems continue to allocate
4317 IV, 11. 6. 4 | associated more with tax-funded health systems to minimize regional
4318 IV, 11. 6. 4 | and the latter with social health insurance systems, in particular
4319 IV, 11. 6. 4 | aims at: a) ensuring all health plans have a fair resource
4320 IV, 11. 6. 4 | base with which to purchase health services for their population;
4321 IV, 11. 6. 4 | the resource base of the health plans according to variations
4322 IV, 11. 6. 4 | regional governments and health insurance funds are often
4323 IV, 11. 6. 4 | in systems with regional health plans that may have different
4324 IV, 11. 6. 4 | costs.~ ~The potential for health insurance funds to identify
4325 IV, 11. 6. 4 | implementation. For example, public health expertise to assess population
4326 IV, 11. 6. 4 | expertise to assess population health needs and outcomes, along
4327 IV, 11. 6. 4 | the cost-effectiveness of health interventions, can be critical.
4328 IV, 11. 6. 4 | central taxes)~National Health Insurance Fund (insurance
4329 IV, 11. 6. 4 | insurance premiums)~Ministry of Health (tax revenue), Municipalities (
4330 IV, 11. 6. 4 | tax revenue)~28 Regional Health Insurance Funds (insurance
4331 IV, 11. 6. 4 | Ministry of Finance~Ministry of Health~MOH~None~Czech Republic~
4332 IV, 11. 6. 4 | Customs (HMRC)~Department of Health~152 Primary care trusts (
4333 IV, 11. 6. 4 | Primary care trusts (regional health plans)~Age, mortality, morbidity,
4334 IV, 11. 6. 4 | Taxation Agency~Estonian Health Insurance Fund with 7 regional
4335 IV, 11. 6. 4 | municipalities, and National Health Insurance~Each municipality
4336 IV, 11. 6. 4 | income base)~Greece~30 social health insurance funds. Ministry
4337 IV, 11. 6. 4 | of Finance. Ministry of Health.~Each fund allocates. Ministry
4338 IV, 11. 6. 4 | of Finance~Department of Health~8 health boards~No capitation.
4339 IV, 11. 6. 4 | Finance~Department of Health~8 health boards~No capitation. Services
4340 IV, 11. 6. 4 | and Regions~Ministry of Health and Regions~21 regional
4341 IV, 11. 6. 4 | Ministry of Finance~Ministry of Health~ ~ ~Netherlands~Ministry
4342 IV, 11. 6. 4 | Fund Scheme~Ministry of Health. Sickness Fund Scheme~26
4343 IV, 11. 6. 4 | Customs (HMRC)~Department of Health~4 health boards (geographically
4344 IV, 11. 6. 4 | Department of Health~4 health boards (geographically based)~
4345 IV, 11. 6. 4 | Ministry of Finance~Ministry of Health~5 regional health authorities~
4346 IV, 11. 6. 4 | Ministry of Health~5 regional health authorities~Age, relative
4347 IV, 11. 6. 4 | spend)~Romania~42 District health insurance funds and 2 national
4348 IV, 11. 6. 4 | security; and Ministry of Health (taxes)~National Insurance
4349 IV, 11. 6. 4 | Insurance Fund and Ministry of Health~42 insurance funds and 2
4350 IV, 11. 6. 4 | Customs (HMRC)~Department of Health~15 regional health boards~
4351 IV, 11. 6. 4 | Department of Health~15 regional health boards~Age, sex, mortality (
4352 IV, 11. 6. 4 | rural costs)~Slovakia~5 health insurance companies~Each
4353 IV, 11. 6. 4 | Age, sex~Slovenia~National Health Insurance Institute~Each
4354 IV, 11. 6. 4 | Spain~Central Ministry of Health~Central Ministry of Health~
4355 IV, 11. 6. 4 | Health~Central Ministry of Health~7 autonomous communities~
4356 IV, 11. 6. 4 | councils and municipalities.~9 health care authorities (geographically
4357 IV, 11. 6. 4 | GERF; Bag-Kur)~Ministry of Health; Social insurance funds~
4358 IV, 11. 6. 4 | insurance funds~Ministry of Health; Social insurance funds~
4359 IV, 11. 6. 4 | Customs (HMRC)~Department of Health~5 health authorities (geographically
4360 IV, 11. 6. 4 | Department of Health~5 health authorities (geographically
4361 IV, 11. 6. 4 | funds are also purchasers of health care services.~ ~Defining
4362 IV, 11. 6. 4 | towards extending coverage to health services to the whole population.
4363 IV, 11. 6. 4 | population to statutory health insurance. In some countries
4364 IV, 11. 6. 4 | systems funded by social health insurance, the attainment
4365 IV, 11. 6. 4 | that public spending on health and social assistance programmes
4366 IV, 11. 6. 4 | fund many and expensive health services are increasing.
4367 IV, 11. 6. 4 | Coverage of a population for health services has been characterized
4368 IV, 11. 6. 4 | essential part of social health insurance systems. Not only
4369 IV, 11. 6. 4 | the Secretary of State for Health (Schreyögg et a.. 2005).~ ~
4370 IV, 11. 6. 4 | the broad frame of social health insurance systems (Gibis
4371 IV, 11. 6. 4 | benefits packages in social health insurance countries to only
4372 IV, 11. 6. 4 | al, 2004). Unlike social health insurance and private health
4373 IV, 11. 6. 4 | health insurance and private health insurance systems, coverage
4374 IV, 11. 6. 4 | coverage through many national health service-type systems is
4375 IV, 11. 6. 4 | the UK, under the National Health Service Act, the Secretary
4376 IV, 11. 6. 4 | the Secretary of State for Health has a duty to provide a
4377 IV, 11. 6. 4 | has a duty to provide a health service ‘to such an extent
4378 IV, 11. 6. 4 | funded system towards social health insurance was believed to
4379 IV, 11. 6. 4 | financed from the social health insurance contributions
4380 IV, 11. 6. 4 | contributions in the hope that health insurance funds could collect
4381 IV, 11. 6. 4 | interventions and public health initiatives. On the other
4382 IV, 11. 6. 4 | Thomson et al, 2004).~ ~Health technology assessment (HTA)
4383 IV, 11. 6. 4 | effects of technology on health, use of resources and other
4384 IV, 11. 6. 4 | and other aspects of the health system (e.g., health care
4385 IV, 11. 6. 4 | the health system (e.g., health care budgets, national economy).
4386 IV, 11. 6. 4 | consequences of implementing health technologies or interventions
4387 IV, 11. 6. 4 | or interventions into the health system. HTA provides a range
4388 IV, 11. 6. 4 | decisions surrounding a given health technology or intervention.
4389 IV, 11. 6. 4 | PROJECT~ ~In recent years, health systems have moved towards
4390 IV, 11. 6. 4 | which they manage public health, focusing on performance
4391 IV, 11. 6. 4 | and the accessibility to health services and on management
4392 IV, 11. 6. 4 | regards the program “Public health: programme of Community
4393 IV, 11. 6. 4 | Community action in the field of health, 2007-2013” states that “
4394 IV, 11. 6. 4 | further deterioration of health, and European reference
4395 IV, 11. 6. 4 | outcomes, that is, patient health status and satisfaction,
4396 IV, 11. 6. 4 | from specific medical and health interventions. Attributing
4397 IV, 11. 6. 4 | that influence patients’ health and satisfaction” (Kane,
4398 IV, 11. 6. 4 | over a period of time. Most health indicators are quantitative
4399 IV, 11. 6. 4 | methods.~The European Public Health Outcome Research and Indicators
4400 IV, 11. 6. 4 | system for benchmarking health outcomes. The first phase
4401 IV, 11. 6. 4 | healthcare systems and sources of health data available to compute
4402 IV, 11. 6. 4 | high clinical and public health importance and because all
4403 IV, 11. 6. 5 | Technology: the Culprit behind Health Care Costs? Washington,
4404 IV, 11. 6. 5 | Office.~ ~Anderson R (2004): Health and health care. Quality
4405 IV, 11. 6. 5 | Anderson R (2004): Health and health care. Quality of Life in
4406 IV, 11. 6. 5 | Understanding informal payments for health care: the example of Bulgaria."
4407 IV, 11. 6. 5 | the example of Bulgaria." Health Policy 62: 243-273.~ ~Barer
4408 IV, 11. 6. 5 | Lomas J. (1987): "Aging and health care utilization: new evidence
4409 IV, 11. 6. 5 | Bartholomee Y, Maarse H (2006): "Health insurance reform in the
4410 IV, 11. 6. 5 | in the Netherlands." Euro Health 12(2): 7-9.~ ~Belli P (2003):
4411 IV, 11. 6. 5 | informal household spending on health: a multicountry study in
4412 IV, 11. 6. 5 | Harvard School of Public Health.~ ~Blendon R, Kim M, Benson
4413 IV, 11. 6. 5 | public versus the World Health Organization on Health System
4414 IV, 11. 6. 5 | World Health Organization on Health System Performance." Health
4415 IV, 11. 6. 5 | Health System Performance." Health Affairs 20(3): 10-20.~ ~
4416 IV, 11. 6. 5 | Results in England." Euro Health 13(1): 13-16.~ ~Brook R,
4417 IV, 11. 6. 5 | al. (1996): "Quality of health care. Part 2: measuring
4418 IV, 11. 6. 5 | International Journal for Quality in Health Care 12(4): 281-295.~ ~Bunker
4419 IV, 11. 6. 5 | et al. (1994): "Improving health: measuring effects of medical
4420 IV, 11. 6. 5 | payment systems in Europe." Health Care Management Science
4421 IV, 11. 6. 5 | undertaking and reporting health technology assessments.
4422 IV, 11. 6. 5 | assessments. Int J Technol Assess Health Care. 2002; 18(2), p 364.~ ~
4423 IV, 11. 6. 5 | countries?" Human Resources for Health 1: 6.~ ~Carter AO, Battista
4424 IV, 11. 6. 5 | European Observatory on Health Systems and Policies.~ ~
4425 IV, 11. 6. 5 | International Journal for Quality in Health Care 12(2): 133-42.~ ~Cheah
4426 IV, 11. 6. 5 | rules and guidelines in health care. Patient Safety: Research
4427 IV, 11. 6. 5 | and Gerard." Journal of Health Economics 11: 93–98.~ ~Culyer
4428 IV, 11. 6. 5 | Equity and equality in health and health care." Journal
4429 IV, 11. 6. 5 | and equality in health and health care." Journal of Health
4430 IV, 11. 6. 5 | health care." Journal of Health Economics 12: 431-57.~ ~
4431 IV, 11. 6. 5 | distributional impact of health financing in Europe: a review.
4432 IV, 11. 6. 5 | Publishing Ltd.~ ~Department of Health (2005): Healthcare Output
4433 IV, 11. 6. 5 | Change. London, Department of Health.~ ~Donabedian A (1980): "
4434 IV, 11. 6. 5 | Quality and Safety in Health Care 11(3): 233-8.~ ~Dovey
4435 IV, 11. 6. 5 | Technology Assessment in Health Care 16(4): 969-975.~ ~Eisenhardt
4436 IV, 11. 6. 5 | Nolte E et al. (2006): Health care outside hospital: accessing
4437 IV, 11. 6. 5 | European Observatory on Health Systems and Policies. Copenhagen,
4438 IV, 11. 6. 5 | Policies. Copenhagen, World Health Organization.~ ~European
4439 IV, 11. 6. 5 | from http://ec.europa.eu/health/ph_publication/eurobarometers_
4440 IV, 11. 6. 5 | International Journal Quality Health Care 13(6): 439-46.~ ~Evans
4441 IV, 11. 6. 5 | ML (1995): "User fees for health care: why a bad idea keeps
4442 IV, 11. 6. 5 | coming back (or, what's health got to do with it?)." Canadian
4443 IV, 11. 6. 5 | and performance in social health insurance systems. Social
4444 IV, 11. 6. 5 | insurance systems. Social health insurance systems in Western
4445 IV, 11. 6. 5 | Figueras. Copenhagen, World Health Organization on behalf of
4446 IV, 11. 6. 5 | European Observatory on Health Systems and Policies: 81-
4447 IV, 11. 6. 5 | Technology Assessment in Health Care 16(4): 1050-60.~ ~Gemmill
4448 IV, 11. 6. 5 | International journal of Equity in Health.~ ~Gibis B, Koch-Wulkan
4449 IV, 11. 6. 5 | benefit decisions in social health insurance systems. Social
4450 IV, 11. 6. 5 | insurance systems. Social health insurance systems in Western
4451 IV, 11. 6. 5 | Figueras. Copenhagen, World Health Organization on behalf of
4452 IV, 11. 6. 5 | European Observatory on Health Systems and Policies: 189-
4453 IV, 11. 6. 5 | 2001): "Equity of access to health care services: theory and
4454 IV, 11. 6. 5 | Does Quality Enter into Health Care Purchasing Decisions?
4455 IV, 11. 6. 5 | Technology Assessment in Health Care 16: 210-27.~ ~Hills
4456 IV, 11. 6. 5 | Reference to the German Health Care System. Bremen:, Centre
4457 IV, 11. 6. 5 | wait.” Journal of Public Health Medicine 16:321-30.~ ~Holland
4458 IV, 11. 6. 5 | European Observatory on Health Systems and Policies.~ ~
4459 IV, 11. 6. 5 | European Observatory on Health Systems and Policies.~ ~
4460 IV, 11. 6. 5 | determine the reimbursement of health technologies (fourth hurdle
4461 IV, 11. 6. 5 | Technology Assessment in Health Care 21(1): 10-18.~ ~Illich
4462 IV, 11. 6. 5 | overview of cost sharing for health services in the European
4463 IV, 11. 6. 5 | proposals. London, Office of Health Economics.~ ~Kanavos P,
4464 IV, 11. 6. 5 | International comparisons of health care expenditures: what
4465 IV, 11. 6. 5 | do not know." Journal of Health Services Research and Policy
4466 IV, 11. 6. 5 | Kelley E, Hurst J (2006): Health Care Quality Indicators
4467 IV, 11. 6. 5 | Economic appraisal of public health interventions. Briefing
4468 IV, 11. 6. 5 | Briefing paper. London, Health Development Agency.~ ~Klavus
4469 IV, 11. 6. 5 | distributional changes in health care financing in Finland."
4470 IV, 11. 6. 5 | in Finland." Journal of Health Services Research and Policy
4471 IV, 11. 6. 5 | Klazinga N (2007): Is the Dutch health care system going private?
4472 IV, 11. 6. 5 | Human: Building a Safer Health System. Committee on Quality
4473 IV, 11. 6. 5 | Committee on Quality of Health Care in America. Washington,
4474 IV, 11. 6. 5 | Critical challenges for health care reform in Europe. R.
4475 IV, 11. 6. 5 | under Germany's statutory health insurance scheme]." Jahrbücher
4476 IV, 11. 6. 5 | primary care systems to health outcomes within Organization
4477 IV, 11. 6. 5 | countries, 1970-1998." Health Systems Research 38(3):
4478 IV, 11. 6. 5 | Avoidable” mortality and health services:a review of aggregate
4479 IV, 11. 6. 5 | Epidemiology and Community Health 44:106-11.~ ~Mainz J, Bartels
4480 IV, 11. 6. 5 | International Journal for Quality in Health Care 18(2): 79-80.~ ~Mainz
4481 IV, 11. 6. 5 | International Journal for Quality in Health Care 16(S1): i45-i50.~ ~
4482 IV, 11. 6. 5 | Quality and Safety in Health Care 14(1): 4-5.~ ~Marshall
4483 IV, 11. 6. 5 | and the United Kingdom." Health Affairs 22(3): 134-48.~ ~
4484 IV, 11. 6. 5 | M et al. (2005): Mental health III: Funding mental health
4485 IV, 11. 6. 5 | health III: Funding mental health in Europe. Policy Brief.
4486 IV, 11. 6. 5 | European Observatory on Health Systems and Policies.~ ~
4487 IV, 11. 6. 5 | Thornicroft G (2005): Mental health II: Balancing institutional
4488 IV, 11. 6. 5 | European Observatory on Health Systems and Policies. Copenhagen,
4489 IV, 11. 6. 5 | Policies. Copenhagen, World Health Organization.~ ~McGrail
4490 IV, 11. 6. 5 | Hübel M (1999): Public Health Policy in the European Community.
4491 IV, 11. 6. 5 | Aldershot: Ashgate~ ~Ministry of Health, W. a. S. (2005): Health
4492 IV, 11. 6. 5 | Health, W. a. S. (2005): Health Insurance in the Netherlands:
4493 IV, 11. 6. 5 | the Netherlands: the new health insurance system from 2006.
4494 IV, 11. 6. 5 | The Hague, Ministry of Health, Welfare and Sport.~ ~ ~
4495 IV, 11. 6. 5 | Weighing heat?" Journal of Health Economics 10: 475–480.~ ~
4496 IV, 11. 6. 5 | heat: Response." Journal of Health Economics 11: 199–205.~ ~
4497 IV, 11. 6. 5 | Dixon A Eds. (2002): Funding health care: options for Europe.
4498 IV, 11. 6. 5 | European Observatory on Health Systems and Policies.~ ~
4499 IV, 11. 6. 5 | Le Grand J Eds. (1999): Health care and cost containment
4500 IV, 11. 6. 5 | Thomson S (2004): Voluntary health insurance in the European
