Because the risk of ill health is part of the human condition, there is a universal interest in providing access to high-quality healthcare while controlling the sacrifices that are necessary to obtain it – after all, the funds used for healthcare cannot be allocated to alternative uses. Affordability is therefore an important consideration that is closely linked to access. Quality determines the health value of the treatment provided. Arriving at a social consensus on how to achieve these goals is difficult, however, which in most countries leads to intense debate on healthcare, as the contributions to this book regarding the US, South Africa, Colombia and the Netherlands all illustrate. Unsurprisingly, there is no one particular healthcare system that meets all three of the needs identified above perfectly. Instead, there is a wide variety of such systems, each with different advantages, disadvantages and trade-offs. Hence it is important that data on the problems encountered are collected and analysed, and that learning occurs between different health systems. This is a practical as well as a scientific challenge, because hitherto most studies on healthcare regulation have not taken a comparative perspective based on comparable data. In fact, in many respects, no such data yet exists. This book charts hospital financing across the three dimensions of access, affordability and quality. It does so based on an international comparison spanning four different continents. For the purpose of our project, we have collected 11 country reports, compiled by national experts according to a standard structure. In addition, six thematic chapters are included that explore specific questions. The invited authors include academics and practitioners (primarily, but not exclusively, policymakers).
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Jos Boertjens, Johan van Manen, Misja Mikkers and Wolf Sauter
An International Comparison of Models and Outcomes
Edited by Wolf Sauter, Jos Boertjens, Johan van Manen and Misja Mikkers
Jos Boertjens and Mary Guy
In this chapter the authors compare the health care systems of England and the Netherlands with respect to contracting, accountability frameworks and the duty to provide care and access to health care. The objectives of contracting are different in these two countries. While in the Netherlands contracting is envisaged to promote efficiency and quality, contracting in England appears to set a minimum requirement. Under the Dutch system, the insurer must fulfill its duty to provide care. In England it is difficult to hold any party accountable for ensuring that patients receive necessary care. Various types of co-payments and out-of-pocket charges occur in both England and the Netherlands. In both countries personal care budgets exist to put patients in charge of their own budgets.
Ulf Bernitz, Moa Mårtensson, Lars Oxelheim and Thomas Persson
The introductory chapter provides an overview of the great social challenge that the EU currently faces. The editors raise the question of what can be done to bridge the prosperity gap in Europe. First, they briefly describe the background: the social dimension of European cooperation and its historical development. Second, they identify the new social challenges that the Union faces in the wake of the Great Recession, the ongoing refugee crisis, and the Brexit referendum. Third, an analytical point of departure for examining these challenges is presented, consisting of an interdisciplinary approach that pinpoints a number of overarching problems and possibilities associated with the social dimension of European integration. Fourth and finally, the book’s chapters are introduced, and their key policy recommendations are summarized. The chapter concludes with the argument that much of the EU’s future relevance and ability to stay together depends on its capacity to counteract the prosperity gap and reverse the negative trend that emerged during the crisis.
The Social Challenge Ahead
Edited by Ulf Bernitz, Moa Mårtensson, Lars Oxelheim and Thomas Persson
This chapter analyses the future of national systems of social insurance in the EU. In Europe, social insurance remains a national responsibility, but the EU’s power to promote the internal market and to develop the social rights connected to EU citizenship challenges the autonomy of the member states. The chapter explains and analyses the tensions that arise in this area when different interests contend. Legal developments in this field raise the question of how the member states’ social security systems should be organized in the future, in conjunction with an expansive body of EU law. The author concludes that the models developed for the future should aim to bridge the gaps in social well-being which currently characterize the EU, without altogether eroding the differences between the welfare models of the different member states. In an increasingly globalized world, the EU’s future lies in community and not in national particularity.
This chapter analyses how the tension between fiscal discipline and responsiveness to popular demands contributes to widening the prosperity gap in Europe. On the one hand, the author argues, the countries most affected by the Great Recession still have a pressing need to strengthen their budget balances and to reduce their debt levels. If they fail to improve fiscal discipline, they will remain vulnerable to economic crises in the future. On the other hand, austerity is often met by public resistance. The political consequences of going against the voters’ preferences can be dramatic and pave the way for populist parties. Thus, governments should not only increase their budgetary safety margins during upturns in the business cycle, but also take measures to increase public support for fiscal discipline. This will reduce the tension they experience between fiscal responsibility and electoral responsiveness.
Edited by Ulf Bernitz, Moa Mårtensson, Lars Oxelheim and Thomas Persson
This chapter looks at how the prosperity gap between the member states is affected by the free movement of workers within the EU. One key purpose of free movement is to even out economic imbalances between the member states. The author’s analysis shows that labour mobility within the Union is too limited to make any significant contribution to economic equalization between the member states. However, mobility still has positive effects in terms of the income gain it implies for the migrants themselves and by helping to reduce labour shortages in specific sectors in specific countries. Contrary to common belief, moreover, migrants contribute somewhat more to the public purse than they cost. The author concludes that the Union and its member states should strive to uphold the free movement of labour, although it has never been as questioned as it is today.
Nicholas Charron and Bo Rothstein
This chapter explores the factors that operate at a societal level to build or destroy social trust. The analysis is based on unique data about the quality of public institutions at the regional level within the EU, and the authors test the tenability of four common explanations for variations in social trust: economic inequality, ethnic diversity, the quality of public institutions, and the degree of political participation by citizens. The analysis shows that the quality of public institutions is the strongest factor underlying regional variations in trust within countries. Economic inequality also proves to be a factor to be reckoned with for explaining variations in social trust. By contrast, the degree of ethnic diversity and the extent to which citizens participate politically have less importance for variations in trust. The overall conclusion is that increasing the quality of public institutions should have first priority if our aim is to reduce the prosperity gap between countries and regions in Europe.