Comparative Health Policy, Second Edition

2 N DE D IT ION REVISED AND UPDATED

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ComparativeHealth Policy Second Edition

Robert H. Blank New Colfege of Fforida and University of Canterbury rrn c'l

Viola Burau University of Aarhus

O RobertH . B tankand V i ol a B urau2OO4,2OO7 Atl r ightsreserved. N o reproducti on, copy or transmi ssi on of thi s p u b Li cati on may be madew i thout w ri tten permi ssi on. No paragraphof thi s publ i cati onmay be reproduced, copi edor transmi tted sa vewi th w ri tten permi ssi onor i n accordance w i th the provi si onsof the Co p y ri ght,D esi gnsand P atentsA ct 1988,or underthe terms of any ti cence p e r mi tti ngti mi tedcopyi ngi ssuedby the C opyri ghtLi censi ng A gency,90 T o ttenhamC ourt R oad,LondonW1T 4LP . An y personw ho doesany unauthori zed act i n retati onto thi s publ i cati on m a y be l i abteto cri mi naIprosecuti on and ci vi lcl ai msfor damages. T h e authorshaveassertedthei r ri ghtsto be i denti fi edas the authors o f th i s w ork i n accordance w i th the C opyri ght,D esi gnsand Pa tentsA ct 1988. F ir stedi ti on2004 Se condedi ti on2007 Pu b ti shed by PAL C R A V MA E C MILLA N Ho u ndmi tl s,B asi ngstoke, H ampshi reR C 216X Sand 1 /5 Fi fthA venue,N ew Y ork,N .Y .10010 Co mpani esand representati ves throughoutthe w ortd PAL C R A VMA E C MILIA Ni s the gl obatacademi icmpri nt of the P aLgrave M a cmi ttandi vi si onof S t.Marti n'sP ress,LLCand of P al graveMacmi ttanLtd. M a cmi [[ani R i s)a regi stered trademarki n the U ni tedS tates,U ni tedK i ngdom a n d other countri es.P atgrave i s a regi stered trademarki n the E uropean Un ionand other countri es. ISBN13:9/8 O 23O 00139 B ISBN -10:0230 00139 4 ISBN13:978 O-23O OO14O4 ISBN10:0 230 00140 B

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T h isbook i s pri ntedon papersui tabLe for recycl i ngand madefrom futty m a n agedand sustai nedforestsources.Loggi ng,pul pi ngand manufacturi ng p r o cesses are expectedto conformto the envi ronmentaL regul ati ons of the co u ntryof ori gi n. A ca t al oguerecordfor thi s book i s avai Labte from the B ri ti shLi brary. A ca tal ogrecordfor thi s book i s avai Labte from the Li braryof C ongress. r0 16

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Contents

Lis t ol lir r rc s , F i g trrc s,tri l ' l i l tl c s

IX

I ' r c ft r t ' t , t o tl tc Sc c o ttdF .d i ti ttrr Lis t ol A lt l trc t,i trti o tts

XV

Conr pa ra ti v c H c i rl d r l )o l i c y : An In troducti on I lc elt h c rl rc i rs p u b l i c p o l i c l ' ( . or r r p rrrrtti v h c c :tl th p o l i c v ( , 1as si fi c rrti o n<sl f h e ra Ithc rrrcs v s rc nrs ( . < lunt ri c ss c l c c tc cfo l r s trrc l y , T v pc s o f h c e l th c rrrc ( ir or v i n s p ro b l c rn si n h c e l th p o l i c y ( . ot t c lr rs i < l n s T hc Co n tc x t o f H c a l th C a rc l r rs t it t rt i o n rrl i s t c r p l en rrti o n :: c o l rtr' .rstinq P ()li ti crtl svstcrrs ( lu lt u rrtl c x p l rrn rrti o n s : c trl ttrrel /h i s tori cal i rtct< l rssha pi ue hc r r lt hc rrrc lrirncti on a l i st ex pl rrn rrti on s: 1'rop rrl rrti on,'uvcrtl tlt a n cl ec oll( ) n lrc s ' l' hc c o n tc x t < l f h c rrl thc a rc F undin g , Pro v i s i o n a n d Gc l v c rn a n cc ( . r lnr p rrri n gfu n c l i n go f h c e l th s y s tcl ns ( lr nt r tn2L"l, now to around 34"1,by peopl e 37.mi l l i on 2050' B y l 0 ' Z ' ' s o m c (r f medi cal perstl rrnel ;anci f inally t he f c d e ra l g o v e rn m c n t w h i c h fu nds Mecl i carc ancl the i oi nt

78

ComParatiuc Hcalth PolicY'

veterans'r r r r d Mecl i cardprogri tnl l l l e i rs w el l as speci al i zecl fe c l e r:a l -state re s e a rc hh ospi tal s. l rrth c l gtJ0,,thcgtl vcrtl l nel l tl .tttcl l l ptecl t< l ,contr()l Mecl i care/ groLrps (D I{ c is) , a spcrrdi ng bv i ni ti ati ng cl i agnosi s-rcl rrtecl v ..i i * i a prtvlllcllt' hrrsrt schcclr'rlcci system unclerwhiclt erlchctrtegor\,'.oi trcrrtnrent g()vcrlllllcllt i a.rcl er t. c' rrstrai tt pri vl tte scctor c()ststhc 1 ,1 ' rt6 c rn r< l rc, crrrc syst elns' thc crel rti .' .f I-l MOs l l tcl .t[cr l l l l l l l i l l aecl c rrc ()u rrt gecl col l tl ri tl :tt i( ) t of l rl i rl cl ucl ccl hl rvc ()th e r rtt t(rl tl ptst., c,uttrol cost grow th trti l i zet iolr rl cg< l ti rtti tl rts, pri ce s e l c c ti v c;rr.l vi cl cr c()l ttrrtcti l rs,cl i scotttl t prl vttl ctl tl l l cth()tl s.t\ftcr thc l cVcllinf lc o u tro l p racttccsJancl ri sl < -shrrri ttg i rl i ti rl ti on oi l )l { (i s r lt lcl O ff ()f h eal th carc crpcncl i trrresi < l l l ol vi rl g thc costs hrtve ri scrl rrr piclly, n ra n e g e clcrrrc i rr thc i atc l c)l J0sto rtti cl 1990s, crr sef or ' i s cs1' rcci rl l l l ' thc ,,g " i ,,' i ,,l.cxccccl i l g gel crrtl i nfl rl ti orl rrtcs.' fhi s gr< l r' vthi s tr< l rvrl P Pr or lch Mc c l i c rrr c/Mccl i crriw clhcrc, cl cspi tcl )l {(i s, rcel i n g c l o trbl ci i gtrrcserl rlttrrll y' S i rl g l l p< l rcl S el l c,X ccpti .,r' t.,thc' rtrl c.l rl 2()()(),rheW tI()r:tl l l :62). In thi s sl ri i t tow rrrcl sc." ' i tk' ncebaseclrrrccl i ci rtc, rrss< l ci. r t iot t s. b c c n p l e c cr-lon thc rol c of profcssi orrell rocl i cserrclsl .rcci rrl i st In fc rc s ti rrgl r'rrs , l rrtcr r' l ,t/. obscrvc, ' si ttcc thc l 9c)0s,sttch svst clt t r t t lc c v l .rl rrrrti orrs...l rrc usctl ,rs l ur i nrportl rnt t()()l to rrssi stp< l l i cynral re s g c i i l l i tts u ra l rcc,w hi ch i s cotl rpl ctrl entecl servi ces i rr l l ri tai rl, hcal th rti rti onal tl .re In coutrr' rst, o f s e l f-a c l rn i n i strrrti on. oi tr()\' crl l l l l cl l t to sl 1111 thc ol l brl sccl rtre N c w Z c a l i rn cl ancl S w ccl crt rccci vc tl l crtl ' As fo pati cl l ts < l f ri ght thc p ro v i d c s e rv i ccsl rs opposcclol l N IIS ,' l tl hi s IJri ti sh thc to H a rri s o n (2 0 0 1:279) 9$scrvcs i n rel rrti < )rr pr()p()l ' rl () lls i rtcrcasi ng (that i s, cap) e l rrb l c sg o v e1 1l l el tts t() " crtsh l i nri t" o f th c rrn n u a lN tl S [rucl gct' . (.< l n C e rtrsA l )otl t c()S tprcsstl rcsl rtrclC < l tl tl ti tl l l l el l t,ttl l i cther rvi th th c l l o v e to a ;l tr[tl i c c()l ttrrl ctrl l < l cl cli rl rl eti onel he:rl th scrvi ccs,l tor' r' cveL I eh ()l l the ;l < l l i ti calegcrl cl, r . Irrv e p u t tl rc i ssl c 6f l esrl i cti rrgtrcr' ttrl tutlhi rttctl l l -l tsto tl cti rl c crl re serl i ccr Zcrtl trncl ' s N cw l ty T h i s i .sw c l l i l lustrrrtccl (.hrtptcr crl scoi l ' ,ri tai rl ,rcsotrrccs i rr thc (p. S i nri l arl v, I l 7). 4 c l i s c u s s c ci n[ to l l l rl l l i l g,cthe ir crtc()tl l ' rrgccl w crc [c c rrl tc ti e h tc r a6cl Icel tl r authori ti cs l ccci vcclcotl sicl reti orti rtg Iu c l g c ts b y s ctti rrgpri ori ti cs. r\t thc sru]l cri nrc, rcsttl t P r< l bel l l yl ost i ts c ra [rl c rn e j c l i artrrclrrc,rrl crni cettcrtti < l rt,tttclrts a (l l : rrri sol t,t ,r1..2()02.).i \ rccetl f crrttl l pl c i s thc N eti onel i r.rr.r< rc c r.rcc -l ' hc usc of sci cttti fi crttl clcvi cl crl ccbrts et l Irrs ti tu tcfo r (l l i ni cel l .-rccl l crrcc. gi vc thc l rl sri ttrtcl cgi ti rl rrcy,yct i ts l vorl < i t ofte ll l sccl c ;i tc ri r i s s L t l -11.r steffccti vc i l l pr()tccti rl gthc ptrl llic .1 r,rr.r.,,' ti trc i l l 1 c s s ,.t,.,.l fr< l r1 c l i s c l rsc.A l though sovcnuncl rts gcttcrl rl l v hrrvc ' uvi cl cl rtrthtl ri t-vt t l oftctt i t i s l l robl cnr d c c l a rc rrn c lenforcc cl r.l rl rrl l ti ncl vi thi rr thci r l t< l rcl cr-s, rrl rni fi cati < l rl srvh ct l ri ghts hutrrr' tt.t scverc i ts of a ti c p < l l i ti c l r l l ,vbccari sc i rrrprct.' l ' hc pol i ti c al cc()l tol tri c i ts potcnti rrl encl c t" .i 3 .:ti ,r1s;1 ' l cci fisr()ups l l t' rerrcti vccel l s t t r i l l trstr.ttccl rvcl l arc .la,,g.r, < l i cl trrrrrrrrti nc ,..' " ,,' ." " ,' .1 rttcchrtrri srloir H I V thc [cf6rc s e g rc g rrtcAl t )S vrcri ptsi rt the rl l i cl l c)l J0s trrrn s tnsi s i o t trvl tsttttcl crstootl . l ,ro tc t.ti n g tl rt' P rrl rl i r-l r..,rl tl r.rl r,,t' ttt:ti l r rt rti tl t' l ' i l l l tl .(' ()l tttotti l ot'it t g to prcvcl l t thc sl l rcrrcl< l f tl i sc:t sc cl csi grrccl ,.,.,ccl .r" r,i srtts e n c l i rrs l ' rc cti ,rr, th rtl g g l r f6 9 cl rrncl w rrtcr suppl i cs, cnvi rotttttctttrtl ,rssrttrl tsel l cl ri s lp l et il llli:il,",i'li:lli:l:'il.1l'il,llili;l[:I'i:l:; "llii::i,i ',1,: Ptttr(ll66l ) (n002)s'rt()srrrtrLi 'rnssl - . r o d t t tt tr r : .lp r ,to - tc1( 6 6 6 t I

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Sinc c public hc elt h c on r p r - i s c ss u c l 'ra b r o a c l r r r t t g co i r l r c i l s , n r l l n v o f r v h i c h i r r l l out s ic lc t hc s c ol- r cof hc l r l t h c i r r c , t h c r c s ( ) u r c c sh e l c i r r c c r p a n s i r " e . A n r o n g t h c bc s t r c c c nt ger r c r alr v or k s o n p u b l i c h c a l t h p c r s c r l r e T L r r n o c k ( 2 ( X ) 4 ) ,S c h r r e i c l c r ( 200. 5) ,M er s on ( 200, + ) ,I l c n c l e r s o r tc t a l . \ 2 0 0 l ) r r n d ( , r r r r c t t ( 2 0 0 0 ) . I l c r t u c h r r n r p r r nc lSt c ir r boc l(( 1999) o f i c r c o r t s t r L r c t i v ci n s i g h t s o n t h c c t h i c r r Jr r s l . r c c fosf p u b l i c hc r r lt h, r v hilc N4ec l< c n z r(el 9 9 l 'i ) p r c s e r r t sr t n h o l i s t i c r r p p r o r r c ht o p u b l i c h c a l t h polic l' . O nc of t hc bc s t g c n c r : r l b o o l <so r t h c r r l t h p r o n r o t i o n i s l ) i ( l l c n r c n t e c l r l l . ( 2002) . l: or r r c or r t pr c h c t t s i v cg t r i c l ct o t h c f r r t t t t e r 'v o r k st.h c o r i c s r r r r c ln r c t l r o c l s r us r c lt o c v r r lur r t c her r lt l r p r o r r ( ) t i ( ) n p r ( ) g r : u l n r e s s c c V e l c n t c ( 2 0 0 2 ) . M o r c s pc c if ic c oLnr t r y -pc r s l- r c c t i v c so r r p u l r l i c h c : r l t h i r r c l r r c l ch o o k s o n l '. u r o p c [ r 1 ' I I ollend r r t t d Nlos s ir t lo s( l r ) c ) 9 ) , t h c L I S A b v N l i l i o ( 2 ( X X ) )r r r r c (l . r t l r r r r t n( 1 9 9 8 ) . Aus t r alir r [ r i. ,Lc c dc r ( 19 9 9 ) e r r r l H r r r r c o c l c i r r t i o rorf A L r s t r al i r r: r v r , v r vp.h r r : r . n c t . r r

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