Changing Healthcare System Types

Abstract

AbstractThis article classifies 32 Organisation for Economic Co‐operation and Development (OECD) healthcare systems based on data from 2001 and 2007. It shows that European countries are clustered in different types of healthcare systems and that traditional typologies are only partially represented in the four types of healthcare systems identified in this study. Type 1 represents countries with low total health expenditure (THE), high public financing, and low out‐of‐pocket payment (OOP). In‐patient healthcare is higher and out‐patient healthcare lower than the OECD average. General practitioners (GPs) are paid by capitation, and patients' access to healthcare is strictly regulated. Type 2 represents countries with an average level of THE, high public financing, above‐average OOP, and high in‐patient and out‐patient healthcare. GPs receive a salary, and access regulation is strict. Type 3 is characterized by very low THE, low public financing, and very high OOP. Both in‐patient and out‐patient healthcare is well below average, and GPs are paid a salary. Type 4 includes systems with the highest THE, the highest public financing, and the lowest direct payments by patients. In‐patient healthcare is below the OECD mean and out‐patient healthcare is well above it. GPs are paid by fee‐for‐service, and most countries offer free choice of medical doctors. The clusters for the years 2001 and 2007 are quite robust. During this time period, THE increased, and patients' access to medical doctors has since become more regulated.