Brian Abel-Smith

Cost containment and health care reform: a study of the European Union

This article gives a short summary of the organisation and financing of health services of the 12 Member States of the European Union. It then describes the latest developments in cost containment in each of the countries. The third section describes the new initiatives for reform in Spain, Italy, the Netherlands, Portugal and the United Kingdom. Finally, it gives a summary of the cost containment measures in the 12 countries, listing them under a set of headings. They are classified as budget control, alternatives to hospital care, cost sharing, influencing authorizing behaviour and limits on supply. The article shows the considerable convergence of policies which is developing. Overall budget control in some form is to be found in 8 of the countries. Where providers are paid by a number of different insurers, budgets are nevertheless applied to hospitals in three countries and in another only to public hospitals. Both Germany and France have used budgets to control other items of expenditure. Profits or the prices of drug companies are controlled in 8 countries and in one indirectly. Three have adopted reference price systems for drugs and another has taken powers to do so. Two have adopted or are moving towards provider markets.

Paying for Health Services. A Study of the Costs and Sources of Finance in Six Countries

Paying for health services: a study of the costs and sources of finance in six countries , Paying for health services: a study of the costs and sources of finance in six countries , مرکز فناوری اطلاعات و اطلاع رسانی کشاورزی

Prospects of Paying for Scientific Advances

The changes in fortunes of the developing world affect the acquisition of technology for these countries. A shrewd minister of health needs to find out 2 things about scientific advances: 1) how many people will it help where and at what cost and 2) whether the additional expenditure provides a less expensive way of getting better results than the present technology. The scale of the investment is also a consideration as is the evaluation research available on efficacy of treatments. The equipment of hospitals and health centers and the training of specialists primary care physicians paramedics workers and midwives also affect the decision to acquire new technology. The nature of the economic climate of developing countries is described as exporting more to maintain the same level of earnings. The dilemma is how to balance export costs with debt payments and how to balance collection of taxes needed for debt service payments with maintaining public services. Devaluation means the country has made itself poorer. 17 African countries devalued their currency and cut public expenditures reduced subsidies and postponed capital investments. Poverty increased. An assessment based on statistical records of how health has been affected is not available because: 1) ministries of health finance only part of public expenditure on health; 2) private expenditure on health is larger than public expenditure; 3) the proportion of the budget on health may be the same but the budget may have decreased; and 4) prices paid for health are variable and not easily available. The inferences drawn are that developing countries were heavily involved in the 1970s in construction of hospitals but the economic crisis of the 1980s meant possibly leaving new hospitals unused. Foreign exchange has contributed to investment in physicians and not replacement or repair of equipment buildings or vehicles and an inadequate supply of drugs. The health sector crunch has not been eased by foreign aid which has remained about the same since 1980 at about 4% from Organization for Economic Cooperation and Development countries. There has also been diversion of aid to countries with greater political or commercial interests. A free trade policy would help as would easing foreign debt. Countries might help themselves by implementing insurance schemes for curative care priorities expenditures and combat poverty malnutrition unsafe water and promote sanitation female education and a better life style. There are no quick solutions.