Health Insurance Reforms In European Countries: Lessons Learned – Private health care delivery in European countries: Recent data and lessons from universal health coverage in other contexts.
Universal health coverage (UHC) is available in all European countries, depending on the ownership structure of the health care system. As countries around the world seek to advance UHC within their health systems and lead the private sector, the European experience can offer useful insights. We found four different models of health care, with the private sector dominant in some countries and the least important in others. European experience shows that UHC can be effectively delivered in large-scale private sector services in hospitals, specialist and primary care, as well as achieving high levels of patient satisfaction. These findings suggest a regulatory model for countries in other regions to review as they advance UHC.
Health Insurance Reforms In European Countries: Lessons Learned
By 2030, there is a movement to make health care accessible to those who need it in all countries. In doing so, many low- and middle-income countries (LMICs) continue to struggle with how and to what extent to integrate the private sector. and inclusion of providers in a formally regulated and funded health care system. This is a pressing question in countries like Nigeria, India, and Myanmar where more than 50 percent of all services are private and quality assurance is a challenge, but it is also relevant in countries like Ethiopia and Vietnam where private care is provided. is below 25%, and policymakers should consider whether higher levels would accelerate investments in coverage and access to care (1–3).
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Ministerial-level platforms such as the Collaborative Learning Network use case studies to provide health workers with examples of key policies related to financing and governance that can advance universal health coverage (4, 5). A case study of health reform was used to illustrate important lessons about regulatory change, systems, and health outcomes (6). Researchers hope to understand how the split between public and private ownership of services affects important health system indicators such as efficiency, morbidity, mortality, and equity. This definition paper aims to establish a system classification and provide a basis for future research in both OECD and LMICs. Health services in Europe are efficient, responsive to citizens, and delivered through varying models and degrees of personal involvement (7, 8). To implement UHC, Europe can provide insight into different practices of private provision within nationally managed systems. This study provides an up-to-date overview of personal services in different sectors in European countries. Experiences are associated with multiple settings.
Providing health care functions that are not dependent on funding is subject to greater competition, disparity, ownership, incentives, and greater variation in care arrangements than funding. However, financing determines the terms of ownership, together with policy and regulatory guidelines, which can directly or indirectly create mixed forms of ownership.
Universal health coverage (UHC) exists in all the European countries we studied. In contrast to LMICs, health care financing in Europe is almost universally managed directly from tax revenues (as in the UK) or semi-directly through social health insurance (as in Germany). Across Europe, government and public health insurance provide a health safety net for almost all citizens, as shown by data from the OECD Health Systems Survey (Figure 1, blue bars). The type of insurance varies between countries, with some (Belgium, Holland, Slovenia) having supplementary private insurance (orange bars) common, while others not (France, Norway) where the most important influence on service delivery is location. , private providers in most countries are paid by the national health insurance system or by a tightly regulated public health insurance system that regulates purchasing (4–6). Out-of-pocket payments for health care are consistently low in all European countries studied, accounting for <0.5% of preventive care costs and <20% of total health care costs in 2018 (9, 10). It is a lesson to other countries that public procurement and regulation is neither a guarantee nor a barrier to a large private market for health care.
Figure 1. Public and private insurance coverage. Blue bars show the population covered by state insurance. Orange bars show the population with private insurance*. *Private insurance supplements public insurance in all countries except the United States, where private insurance replaces public insurance. Countries without private insurance were not reported to the OECD in 2018. (Source: https://stats.oecd.org/).
European Single Market
We analyzed only European OECD countries. We excluded non-OECD EU members and non-European OECD countries. Turkey is an OECD member country and is partially in Europe, but 97% of its land area is in Asia, so we decided to exclude it from this analysis. In this article, we refer to the selected countries as “Europe” for simplicity.
We reviewed all articles on the health systems of the participating countries from the OECD and WHO European websites. For each country, we searched English-language journal articles through PubMed and Google Scholar, and if data were inconsistent or missing, we referred additional sources from the white paper by country (e.g., “dentist Luxembourg”) by Google Scholar topic. searched. When all these sources failed, we contacted WHO experts and private associations of academic institutions in countries with data shortages for additional sources in other languages.
To estimate the extent of the role of the private sector in each country, we relied heavily on the National Health Systems in Transition (HSiT) report from the European Observatory on Health Systems and Policies. These ranged in production date from 2003 (Iceland) to 2019 (Latvia) (11, 12). Where country-specific reports used data prior to 2008, regardless of when they were published, we set them aside and used data from the 2008/9 OECD Health Systems Survey instead (8). When journal publications or national reports had more recent reliable national data than the 2008/9 survey or national HSiT report, we used that source. The year of data used for each country is shown in the supplementary material.
We used the OECD classification of health services to consider inpatient services, specialty services, primary care, and pharmacy separately (8, 13). We use hospitals as a proxy for inpatient care, which represents the majority of care providers in hospitals across all countries surveyed (14). Ambulatory specialist services and dental treatment are provided together. Primary care may be a general practitioner (UK) or a primary care center (Sweden). The pharmacies listed here only refer to community pharmacies and therefore do not include hospital-based pharmacies.
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This study used publicly available data to examine health system behavior. No patients were enrolled, and no direct data were collected for community participation.
We assessed each country for hospital ownership data and then checked for consistency with other aspects of care. From this, we grouped European healthcare systems into four categories (Figure 2), depending on how dependent they are on private provision. This grouping is characterized by an analysis of the regulatory and purchasing interactions between public and private providers of care in the health care sector (15-17). Health systems are highly path-dependent (18, 19), and the four categories, or Clusters, reflect the continuing influence of the funding and ownership models that have shaped the current structure. In Germany, the influence of the Bismarckian model of social insurance and private contract delivery is still evident (20). In Great Britain, the influence of Beveridge’s ideas on the national health system continues today (21). However, as Kutzin convincingly argued a decade ago, differences in European health systems are becoming less important as they adapt to funding models driven by aging populations and rising expectations of care, whereby government funding replaces traditional public health insurance. filling the gap, while cost-control competition is increasingly common in national health insurance systems (22–24).
Hospitals are undergoing a transition across Europe as ambulatory services move outside of hospital settings and most countries seek to increase efficiency through reduced average length of stay and higher bed utilization (14, 15). Our findings from countries with more recent data differ slightly from the ownership status summarized in a 2008/2009 survey of OECD countries (8). In all European countries, the role and importance of private hospitals in the larger health system falls into four different categories (Figure 2).
The behavior of private hospitals varies among the four groups, as can be seen in how private hospitals contribute to the number of inpatient beds in each group (Figure 3). In some countries, private hospitals provide inpatient beds and services based on their overall system importance; private hospitals in other countries have very few beds and instead provide only outpatient care. In group 1, the number of beds in private hospitals almost corresponds to the number of private hospitals: all types of inpatient care are provided here. As in Germany, where public and private hospitals coexist, there is a difference in services
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