Abstract
BackgroundHealth systems delivery systems can be divided into two broad categories: National Health Services (NHS) on the one hand and Social Security (based) Health care systems (SSH) on the other hand. Existing literature is inconclusive about which system performs best. In this paper we would like to improve the evidence-base for discussion about pros and cons of NHS-systems versus SSH-system for health outcomes, expenditure and population satisfaction.MethodsIn this study we used time series data for 17 European countries, that were characterized as either NHS or SSH country. We used the following performance indicators: For health outcome: overall mortality rate, infant mortality rate and life expectancy at birth. For health care costs: health care expenditure per capita in pppUS$ and health expenditure as percentage of GDP. Time series dated from 1970 until 2003 or 2004, depending on availability. Sources were OECD health data base 2006 and WHO health for all database 2006. For satisfaction we used the Eurobarometer studies from 1996, 1998 and 1999.ResultsSSH systems perform slightly better on overall mortality rates and life expectancy (after 1980). For infant mortality the rates converged between the two types of systems and since 1980 no differences ceased to exist.SSH systems are more expensive and NHS systems have a better cost containment. Inhabitants of countries with SSH-systems are on average substantially more satisfied than those in NHS countries.ConclusionWe concluded that the question 'which type of system performs best' can be answered empirically as far as health outcomes, health care expenditures and patient satisfaction are concerned. Whether this selection of indicators covers all or even most relevant aspects of health system comparison remains to be seen. Perhaps further and more conclusive research into health system related differences in, for instance, equity should be completed before the leading question of this paper can be answered. We do think, however, that this study can form a base for a policy debate on the pros and cons of the existing health care systems in Europe.
Highlights
Health systems delivery systems can be divided into two broad categories: National Health Services (NHS) on the one hand and Social Security Health care systems (SSH) on the other hand
We concluded that the question 'which type of system performs best' can be answered empirically as far as health outcomes, health care expenditures and patient satisfaction are concerned
Perhaps further and more conclusive research into health system related differences in, for instance, equity should be completed before the leading question of this paper can be answered
Summary
Health systems delivery systems can be divided into two broad categories: National Health Services (NHS) on the one hand and Social Security (based) Health care systems (SSH) on the other hand. The inclusion of a country's system into one of the two categories is mainly based on the way the systems are funded (general taxation versus earmarked premiums) but these funding differences correlate with differences in the way the systems are organised (See Table 1) This subdivision into two big groups covers mainly all (West-) European health care systems. Many aspects of both categories of systems have been studied and described [8,9,10,11,12,13,14,15,16,17,18,19,20,21], but one would have expected that the crucial question: which system is best, which should be preferred, would have been a 'Leitmotiv' in the wealth of studies (see [22]) This is not the case, : the question, in its primitive or in a more sophisticated (that is: by specifying the criteria of comparison) form has rarely been posed and, if so, the answer was mostly inconclusive. Elola called the overcoming of this trade-off of outcomes between the two types of systems a main goal of health care reforms. [23]
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