版權(quán)說明:本文檔由用戶提供并上傳,收益歸屬內(nèi)容提供方,若內(nèi)容存在侵權(quán),請進(jìn)行舉報或認(rèn)領(lǐng)
文檔簡介
1、8500 英文單詞, 英文單詞,4.9 萬英文字符,中文 萬英文字符,中文 15800 字文獻(xiàn)出處: 文獻(xiàn)出處:Simonet D . Healthcare reforms and cost reduction strategies in Europe: The cases of Germany, UK, Switzerland, Italy and France[J]. International Journal of Health
2、Care Quality Assurance, 2010, 23(5):470-88.Healthcare reforms and cost reduction strategies in EuropeThe cases of Germany, UK, Switzerland, Italy and FranceDaniel SimonetAbstractPurpose – This paper aims to analyse healt
3、h reforms carried out in a sample of European countries. Design/methodology/approach – Using a country-specific approach, outstanding health reform features such as: greater competition between sickness funds in Germany;
4、 fund-holding practices in the UK; managed care models in Switzerland; health networks in France; and healthcare system decentralisation in Italy are analysed.Finding – There have been different approaches to controlling
5、 healthcare costs. Some states relied on public sector competition by creating quasi-markets (UK), insurance sector competition, particularly in Switzerland and Germany, organisational reforms in France by creating healt
6、h networks and decentralisation in Italy.Research limitations/implications – Societal and legal aspects are not discussed. Originality/value – The paper compares healthcare reform effectiveness in a number of western
7、 European countries.Keywords: Health services, Public sector reform, European UnionIntroductionAlthough the Bismarck and Beveridge doctrines inspired European health systems, both clashed during the second half of the tw
8、entieth century. The Bismarck model dates back to 1880 and covers the working population (for accidents, diseases, disability and retirement). Three laws:·1883 (sickness insurance);·1884 (work injury insurance
9、), which later became the statutory industrial accident insurance; and·1889 (disability and elderly care), which became the statutory pension insurance, laid down its foundations.The Bismarck doctrine was based on p
10、aid work. Social security benefits were only granted to those who worked; health services and financial contribution depended on income level. Unemployed and pensioners, on the other hand, were excluded from the system.
11、Nevertheless, it offered a generous protection to workers; for example, the first industrial laws held firms responsible for work injuries. Its influence was great in Italy, France and Sweden.Beveridge (Churchill’s Healt
12、h Minister) model is a more recent and liberal doctrine. It was developed in a working paper compiled in Great Britain and diffused in 1942 under the title Social Insurance and Allied Services that came into effect in 19
13、48. It imposed universal coverage (which differs from the Bismarck model because it was not restricted to salaried workers). Beveridge was funded through taxation and also responded to many other non-health concerns (e.g
14、. integrating the former East Germany, generated additional expenditure.The healthcare system was partially liberalised after adopting the Seehofer reform. The 1992 version led to a switch from a per-bed, per-day payment
15、 to global budgeting. It included other drastic measures such as suppressing hospital beds and greater physician-practice regulations. In 1993, fixed budgets were attributed to each hospital and managers were free to use
16、 budget surpluses. In 1996, flexible budgets were adopted, and included per diem payments and payment per cases adjusted to take into consideration local population characteristics. Target budgets were added: if spending
17、 goes beyond a certain cap defined by a global budget then both hospital and insurer must cover the excess. In 1996, competition between insurers was instilled into the system, which led to equalising patient premiums. T
18、he reform instituted choice, which can be terminated by the insured, has compensation mechanisms aimed at preserving equity and access to care for all. Competition also stimulated insurer concentration and aimed at impro
19、ving public insurer competitiveness against private insurers. However, none of these mechanisms was original. In 1986, The Netherlands adopted the Dekker reform leading to more competition between insurers and freedom of
20、 choice for the insured. The difference with the German model was the priority given to health networks. To this were added other measures to foster ambulatory surgery, residential care services, prescribing generic drug
21、s and formulating a German health network (i.e. Das Deutsche Gesundheitsnetz). Authorities regulated medical staffing because physician and equipment density were already high, and experimented with physician networks in
22、 Berlin. These were close to Switzerland’s gate keeping experiments (Himmel et al., 2000; Ratajcak, 1998). Though health expenditure stabilised, there were occasional deficits (nearly 20 billion Marks in 1995). Lastly, t
23、he system was poorly coordinated; there were occasional conflicts between social security system and hospitals.In July 2001, Werner Muller, then Economy Minister, proposed insurance capitalisation to replace traditional
24、insurers. Employers’ insurance contribution was then paid directly to the employee who would choose any private insurance. The contribution to the sickness fund would be equally shared by employee and employer; this newl
25、y-proposed insurance also aimed to stabilise or reduce employer contribution to sickness funds (which can reach up to 15 per cent of the gross salary). Unlike Switzerland where fees vary across cantons, German premiums v
26、aried across sickness funds, and another reform objective was to reduce variations. However, many healthcare players (e.g. public insurers) were hostile to the reform.Decentralisation had been on the agenda before taking
27、 the opposite direction in the 1990s. With the federal government seeking to reduce its involvement in healthcare management, regions (i.e. Landers) were to manage hospitals economically: Landers are in charge of plannin
28、g and financing new hospital buildings and other large investments while statutory health insurance companies pay for most hospital operating costs. But decentralisation is neither a cost-containment measure per se nor s
29、hared by all nations in our sample: the Swiss healthcare system “became more centralised and nationally uniform” after the federal Health Insurance Law (Krankenversiche-rungsgesetz) was adopted in 1994, which took effect
30、 in 1996 (Reinhardt Uwe, 2004). With more than 1,000 different sickness funds in the early 1990s (reduced to less than 500 in 1998), the German system was pluralistic with private, social (not for profit) and public comp
31、onents rather than a dichotomous public/private system: there are different private providers for outpatient care and public, social and private providers for inpatient care: influential stakeholders are one of the Germa
溫馨提示
- 1. 本站所有資源如無特殊說明,都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等,如果需要附件,請聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
- 3. 本站RAR壓縮包中若帶圖紙,網(wǎng)頁內(nèi)容里面會有圖紙預(yù)覽,若沒有圖紙預(yù)覽就沒有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 眾賞文庫僅提供信息存儲空間,僅對用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理,對用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯,并不能對任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容,請與我們聯(lián)系,我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時也不承擔(dān)用戶因使用這些下載資源對自己和他人造成任何形式的傷害或損失。
最新文檔
- [雙語翻譯]醫(yī)療改革外文翻譯--歐洲的醫(yī)療改革和降低成本的策略(英文)
- 2010年醫(yī)療改革外文翻譯--歐洲的醫(yī)療改革和降低成本的策略
- 2010年醫(yī)療改革外文翻譯--歐洲的醫(yī)療改革和降低成本的策略.DOCX
- 2010年醫(yī)療改革外文翻譯--歐洲的醫(yī)療改革和降低成本的策略(英文).PDF
- 企業(yè)降低成本的策略探析
- 降低成本
- 降低成本措施
- 現(xiàn)場降低成本的方法
- 12 降低成本措施
- 降低成本措施 2
- 12 降低成本措施
- [雙語翻譯]--(節(jié)選)外文翻譯---中國醫(yī)療制度改革關(guān)于自付費用和儲蓄的影響
- 淺談降低成本的若干措施
- 項目施工降低成本的措施
- 關(guān)于降低成本水平的探討
- 12 降低成本措施.doc
- 降低成本檢查表
- [雙語翻譯]--(節(jié)選)外文翻譯---中國醫(yī)療制度改革關(guān)于自付費用和儲蓄的影響(原文)
- [雙語翻譯]--(節(jié)選)外文翻譯---中國醫(yī)療制度改革關(guān)于自付費用和儲蓄的影響(譯文)
- 淺析企業(yè)降低成本的主要途徑
評論
0/150
提交評論