Health-Care Systems: Lessons from the Reform Experience

Abstract

This study presents a broad overview of health-system reforms in OECD countries over the past several decades. Reforms are assessed according to their impact on the following policy goals: ensuring access to needed health-care services; improving the quality of health care and its outcomes; allocating an appropriate level of pubic sector and economy-wide resources to health care (macroeconomic efficiency); and ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomic efficiency).While nearly all OECD countries have achieved universal coverage of health-care risks, initiatives to address persistent disparities in access are now being undertaken in a number of countries. In light of new evidence of serious problems with health-care quality, many countries have recently introduced reforms intended to improve this, but it is too soon to generalise as to the relative effects of alternative approaches. A variety of instruments aimed at cost control have succeeded in slowing the growth of (particularly public) health-care spending over the 1980s and 1990s but these have not addressedthe root causes of growth and health-care spending continues to rise as a share of GDP in most countries. On the other hand, a few countries have been concerned that spending restrictions have gone too far and hurt health system-performance. There is some evidence that supply of health services has become more efficient, particularly in the hospital sector, but scope for further gains exists. A range of measures, such as better payment methods, have improved the microeconomic incentives facing providers. However,introducing improved incentives through a more competitive environment among providers and insurers has proved difficult.