Policy Choices Relating to Social Health Care Schemes

Abstract

Twelve areas of reflection are presented in this chapter that are related to choices confronting all social health care systems. These are choices that may significantly influence the satisfaction of the population with the health care system. Moreover, these choices may determine to what extent the social health care system of a country proves to be sustainable. A first set of issues concerns the borders of the social health care system and we ask what its territorial scope should be, how the areas of social health care and private health care should be defined, and whether health care should be for all or only for the socially insured. We also address the question of whether limits should be set to the availability of health care, and if so, what they should be. All social health care systems, be they national health systems or social insurance systems, will have to make choices related to in-kind or reimbursement-based benefits, the co-payments by patients and freedom of choice regarding health care providers. We examine the advantages and disadvantages of such systems. All countries struggle with the way in which they finance social health care and ask themselves what the best way to employ and/or pay health care providers is. The responsibilities of the health professional and the patient must be defined. Finally, we discuss the impact of medical liability on social health care schemes.