International Health Care Reform: A Legal, Economic, and Political Analysis

By Colleen M. Flood | Go to book overview

3

The reform of health care allocation systems in the US, the Netherlands, New Zealand, and the UK
This chapter provides an overview of the US, Netherlands, New Zealand, and UK health care systems. I discuss the four countries in a sequence that reflects a continuum in terms of levels of private funding and private delivery. At one end of the spectrum, the US relies to the greatest degree on private funding and private supply whereas at the other end, the UK relies to the greatest degree on public funding and provision. The Netherlands falls along this continuum closer towards the US, but there is a fundamental and crucial distinction with respect to access. Through regulation, the Netherlands ensures that the poorest 60 percent of the population are covered for comprehensive care, and that the entire population is covered for “exceptional” medical expenses. New Zealand falls closer on the continuum towards the UK, but what distinguishes New Zealand is its relatively high reliance on private financing (by patients themselves and by private insurance) for general practitioner services. This chapter has four objectives:
• to discuss the cost and access problems that prompted reform in the late 1980s and early 1990s in all four countries (hence why some of the earlier figures discussed appear dated);
• to describe and discuss the reforms implemented or proposed in the early 1980s and 1990s;
• to briefly canvass progress and changes in the reform agendas since that time; and finally,
• to compare the structure and dynamics of the four health care systems in order to identify those key features of a system that will efficiently achieve access for all citizens to a comprehensive range of health care services on the basis of need as opposed to ability to pay.

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