2005 seminar 1: choosing country health politics ana rico, associate professor department of health...
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2005
Seminar 1: Choosing country
Health Politics
Ana Rico, Associate ProfessorDepartment of Health Management and Health
2005
CONFIGURATIONS
COUNTRIES Success NHI
Failure NHS
5 factors +: SUELC4 factors +: SuELC
SUeLCSUElC
Sweden, NorwayAustriaDenmark, FinlandLuxemburg
2121
0000
3 factors +: sUELc
SUeLcSUElcSUelCSueLC
United Kingdom, New ZealandIcelandFranceJapanBelgium, Germany, Netherlands
21113
00000
2 factors +: SUelc
sUElcSuELcsueLC
ItalyIrelandAustralia, CanadaSwitzerland?
1110
0001
1-0 factors +: suelC
suelc
Switzerland?USA
00
11
DETERMINANTS OF NHI REFORM: QCA measurementDETERMINANTS OF NHI REFORM: QCA measurement
Supportive culture Unitary Executive dominance Left rule Corporatism
2005
1. In the most generous WS, all 5 causes present: NOR, SWE
2. Given a supportive culture, a left party, and a corporatist pattern of IGs intermediation, NHI enacted even if unfavourable political institutions
AUS, DEN, FIN, BEL, GER, NETH
3. Unitary states with supportive cultures, enacted NHI even if rest of conditions unfavourable
ICE, FRA, ITA, JAP
4. Anglosaxon countries with a dominant executive and left parties enacted NHI in spite of rest of factors unfavourable
UK, IRE, CAN, AUSL, NZ
5. Causes of American excepcionalism: “The USA [is] the only country with unfavourable conditions in all 5 vars.”
DETERMINANTS OF NHI REFORM: AnalysisDETERMINANTS OF NHI REFORM: Analysis
MAIN CONCLUSION: “To date, the absence of favourable [(political) institutions] has only been overcome by the simoultaneous presence of all three other supportive factors (culture, labour party, corporatism)”
2005
THE US EXCEPTION IN HEALTH & WELFARETHE US EXCEPTION IN HEALTH & WELFARE
1930s: Succesful pro-poor WS (cash transfers) reform BUT failed health care reform 1. Success WS + 2. failure HC
• Europe: 1880-1930 pro-poor WS + HC
1960s-1970s: Succesful pension reform, limited unemployment reform, and very limited (pro-poor & aged) health care reform Partial success WS + limited success HC
• Europe: 1945-1970s
1993-4: Failed universal health care reform Failure HC• Europe: 1945-1970s (But Switerland 1999)
1970s-2000s. Further expansion of coverage/programmes
Some retrenchment & re-structuring
EVIDENCE: 2. NORTH AMERICA
2005
Source: McKee, 2003
2005
GASTO PÚBLICO PER CÁPITA EN US$-PPP, 1995
200018001600140012001000800600400
% S
AT
ISF
EC
HO
S,
19
96
100
80
60
40
20
0 Rsq = 0,5085
UK
SWE
SPA
POR
NET LUX
ITA
IRE
GRE
GERFRA
FINDEN
BEL
AUS
PER CAPITA PUBLIC EXPENDITURE 1995
% S
AT
ISF
IED
WIT
H H
C S
YS
TE
M, 1
996
CANADA
US
2005
PUBEXP97
18001600140012001000800600
SA
T9
8100
80
60
40
20
0 Rsq = 0,7314
UK SWE
SPA
POR
IRE
GRE
FIN
DEN
2005Gráfico 5. Satisfacción con el sistema sanitario,
en los países de la Unión Europea (EU) 1996-1999
0 20 40 60 80 100
Greece
Portugal
Italy
Spain
Ireland
Germany
U. Kingdom
EU
Sweden
Luxembourg
Netherlands
Finland
Denmark
Belgium
France
Austria
Porcentaje de la población satisfecha
1996
1998
1999
% CITIZENS SATISFIED WITH THE HEALTH CARE SYSTEM
Source: Eurobarometers. Data provided by H Dubois (European Observatory, EOHSP) and A Dixon (LSE, EOHSP). On the US: Blendon R Kim M Benson J (2001) The public vs. WHO on health system
performance, Health Affairs, 20, 3: 10-20.
Canada 1998
US 1998
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