Social Health Insurance Systems in Western Europe

By Richard B. Saltman; Reinhard Busse et al. | Go to book overview

chapter three
Organization and financing
of social health insurance
systems: current status and
recent policy developments

Reinhard Busse, Richard B. Saltman and Hans F. W. Dubois


Introduction

This chapter probes more deeply into the complex technical commonalities and variations among the seven social health insurance (SHI) countries in western Europe, and Israel. Reflecting the four-level pyramid model introduced in Chapter 1 (Figure 1.2), this chapter details the structural characteristics, respectively from its top, of the funding, organization and (to a lesser degree) state levels of SHI systems as well as recent developments. Since the funding flows are inextricably linked to the institutions that organize SHI systems, these top two tiers will be reviewed simultaneously, followed by the role of the state. As the four-level pyramid model highlights, these financial and organizational relationships are embedded within, and heavily steered by, the two lower levels of the pyramid (e.g. the state and, below that, the broader society in which the state sits).

The chapter is organized into three main sections. In the first, the eight SHI systems, as they are currently configured, are described in relation to ten key structural dimensions. This is followed by a brief review of the role of the state in these systems. In the third section, the main trends of recent policy developments in the eight studied SHI systems are categorized and assessed.

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