If a dart were thrown at a map of the world and one identified the national capital nearest the dart, the following would be a safe prediction: somewhere in that capital a task force is busily at work on yet another a blueprint for health-care reform. The prediction is safe because, at any time, in any nation, there is widespread malaise over that nation's health system. Furthermore, the alleged shortcomings of the current system are everywhere the same.
The objective of this report is to provide an assessment of the reform process of the health care sector in the Countries of Central and Eastern Europe (CCEE). It shall assess the overall direction of the reforms and focus in particular on health financing and pharmaceutical policy making as two important elements of structural reform. The first part of this report provides a brief overview of the state of health of CCEE populations and the process of health care reform. The second part of the report discusses health financing and pharmaceutical policy reform.
Faced with the growing pressures on health care budgets, policy makers around the world have turned to different forms of direct charging for health services. However, because it is rare to find a health system where the user is faced with the full cost of the service, these charges are often referred to as cost sharing. That is, the cost of the service is shared between the user and some third party payer, typically a sickness fund, insurance company or government agency.
Increases in expenditure on medicines, above the level of increases in health care expenditure generally, are a feature of all Western health systems, including the UK's. This paper examines the causes of these increases in the UK. It reports on a study carried out by the Office of Health Economics, with technical assistance from the Department of Health, under the auspices of the Industry Strategy Group, a forum for joint discussion of matters of strategic interest to the pharmaceutical industry and the Government.
In April 1991, a radical programme of public health care reform was introduced by the Conservative Government. The avowed intention of the programme was to improve the overall quality of health care whilst simultaneously moderating the growth in costs. Within the general reform package, prescribing in general practice was a particular focus of attention.
Much has been written over the last 40 years bemoaning the state of NHS waiting lists. Contributions to this literature have come from diverse fields; from epidemiologists, surgeons, statisticians, operations researchers, managers and social scientists (Pope, 1990) (Mullen, 1993), (Yates, 1987).
In this OHE lecture Professor Sackett sets out a compelling case for evidence-based medicine to be at the core of a comprehensive, tax-funded NHS that enjoys the confidence of the whole population. He also sets out his personal view as to how the conflict between a doctor's responsibilities to each individual patient and to society can be minimised and managed, but not eliminated.
The idea that clients or users of public services might legitimately have opinions about how they should be delivered is a relatively new one in the United Kingdom, where producers' views have dominated decisions about how things should be done. This tendency can be observed not only in health care, but also in other public services such as education, the provision of social security benefits, policing, and the criminal justice system. Such neglect of users' views is predictable where services are provided (often for excellent reasons) in a non-market context.
The chapters in this book are based on the contributions to a conference organised by the Office of Health Economics and held at the Zoological Society of London on 13 September 1995. The various contributions, from many distinguished authors from the United Kingdom, continental Europe and the United States highlight many aspects of the international debate about the future of primary care.
The seemingly inexorable rise in real health care costs (i.e. over and above the rate of inflation) has been a cause of great concern to governments throughout the world. Few economists in the world are better qualified than William Baumol to help us understand what is driving up real cost and how we can design a health care system that enables us to live with these cost increases.