Social Health Insurance Systems in Western Europe

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

chapter six
Governance and
(self-)regulation in social
health insurance systems

David Chinitz, Matthias Wismar and Claude Le Pen


Introduction

Long before ‘the Third Way’ became the reformist buzzword of 1990s public policy, social health insurance (SHI) systems had evolved as a uniquely structured institutional arrangement that inhabited the social space between purely public (e.g. state) as against purely private (e.g. for-profit) modes of health sector organization. Although no western European health care system has accepted the social, economic or political risks inherent in relegating health care finance and delivery to a totally private market, nearly as many countries have chosen to adopt a social insurance approach as have adopted a tax-funded framework i.e. to be a Bismarck- rather than a Beveridge-type system.

This chapter is, however, about one of the main components of SHI systems, the structure for governance and regulation. It seeks to explore a number of key issues that influence the basis for, and the legitimacy of, SHI systems. Among these are the following: What is the distribution of authority among public, notfor-profit private and for-profit private entities? What are the relative roles of legislative, executive and judicial bodies? What is the legal structure and how are health care funding and delivery regulated? What challenges are posed for coordination among various agencies involved in this policy-making and regulatory network, and between the regulatory agencies and the professionals and provider groups in the health system? What are the mechanisms of accountability in such systems and how well do they function? Moreover, what impact do alternative SHI frameworks have on outcomes of the system such as equity, efficiency and responsiveness? Finally, what is the likely future of such

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