Health Systems Institutional Characteristics:
a survey of 29 OECD Countries
Valerie Paris, Marion Devaux and Lihan Wei
OECD HEALTH WORKING PAPERS No. 50, 2010-05-10
Organisation for Economic Co-operation and Development OECD 28-Apr-2010
Available online PDF [140p.] at:
http://www.olis.oecd.org/olis/2010doc.nsf/LinkTo/NT000029DA/$FILE/JT03282545.PDF
“…..This paper presents the informaton provided by 29 of these countries in 2009. It describes country-specific arrangements to organise the population coverage against health risks and the financing of health spending.
It depicts the organisation of health care delivery, focusing on the public/private mix of health care provision, provider payment schemes, user choice and competition among providers, as well as the regulation of heallth care suppply and prices.
Finally, this document provides information on governance and resource allocation in health systems. (decentralisation in decisionmaking, nature of budget constraints and priority setting)….”
TABLE OF CONTENTS
1 INTRODUCTION
2 HEALTH FINANCING AND COVERAGE ARRANGEMENTS
2.1 Characteristics of basic primary health care coverage
2.2 Regulation of health insurance markets in countries with multiple insurance funds
2.3 Consumer choice and competition between health insurers offering basic primary health care coverage
2.4 Interventions of the public sector to ensure coverage of high-risk or low-income people in non-NHS systems
2.5 Protection against excessive out-of-pocket payments
2.6 “Over the basic” health care coverage
2.7 Financing health care
3 HEALTH CARE DELIVERY
3.1 Organisation of health care supply
3.1.1 The provision of outpatient physician services: organisation and public/private mix
3.1.2 The public/private mix in the provision of acute hospital care
3.2 Payment of health care providers
3.2.1 Predominant modes of physician payment
3.2.2 Payment of hospitals for acute inpatient care
3.2.3 Bonuses or penalties in relation to performance targets
3.3 User choice and competition among providers
3.3.1 Patient choice among providers
3.3.2 Gate-keeping
3.3.3 Information on quality and prices of providers services
3.4 Regulation of health care supply
3.4.2 Regulation and density and distribution of physicians in OECD countries
3.4.3 Regulation of hospital supply and of the diffusion of high-cost medical technologies
3.5 Price/fee regulation
3.6 Regulation and monitoring of health provider activity
3.7 Co-ordination of care
4 GOVERNANCE AND RESOURCE ALLOCATION
4.1 Degree of decentralisation of decision-making
4.2 Definition of health care budget and pressure for cost-containment
4.3 Priority setting and public health targets
4.3.1 The use of health technology assessment
4.3.2 The definition of the health benefit basket
4.3.3 The definition of public health objectives
4.4 Patient’s rights and involvement in health care systems
4.4.1 Patient rights
4.4.2 The tort system and the possibility to engage class actions
4.4.3 Patients’ representation and involvement in decision-making
5 CONCLUSION
6 ANNEXES
7 REFERENCES
* * *
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