Abstract
Healthcare systems in the early 1970s, the so called 'golden age' of the welfare state, came much closer to what we characterize as distinct ideal types: the Private Insurance System, the Social Insurance System and the National Health Service (NHS). During the past decades, as a consequence of problem pressure caused, for example, by globalization and demographic change, healthcare systems have grown more alike and become 'hybrid' over time. This can be interpreted as a form of healthcare system convergence. One possible explanation for this convergence is that systems have learned from one another. In our contribution, we show that DRGs (1) provide a convincing example for policy learning and the diffusion of ideas in healthcare systems and (2) corroborate our argument regarding system convergence and hybridization. Taking the United States, England, and Germany as examples, we show that these most distinct cases of healthcare systems have implemented DRGs, yet with very different objectives and consequences.
Highlights
Healthcare systems in the early 1970s, the so called 'golden age' of the welfare state, came much closer to what we characterize as distinct ideal types: the Private Insurance System, the Social Insurance System and the National Health Service (NHS)
diagnosis related groups (DRGs) were first developed in the US private insurance system at a time when healthcare cost was continuously rising
In 1992, the British NHS adopted an analogous version of DRGs, referred to as Health Resource Groups (HRGs)
Summary
Healthcare systems in the early 1970s, the so called 'golden age' of the welfare state, came much closer to what we characterize as distinct ideal types: the Private Insurance System, the Social Insurance System and the National Health Service (NHS). As a consequence of problem pressure caused, for example, by globalization and demographic change, healthcare systems have grown more alike and become 'hybrid' over time. This can be interpreted as a form of healthcare system convergence. We show that DRGs (1) provide a convincing example for policy learning and the diffusion of ideas in healthcare systems and (2) corroborate our argument regarding system convergence and hybridization. Taking the United States, England, and Germany as examples, we show that these most distinct cases of healthcare systems have implemented DRGs, yet with very different objectives and consequences
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