The general objectives of healthcare policy in the Netherlands can be summarized as accessibility, affordability and quality improvements. Set against the background of these three objectives, the Netherlands’ system of healthcare has undergone thorough-going reform over the past decade, in the areas of both long-term care and curative care. The aim of the Health Insurance Act was to introduce health insurance for all residents and it accords an important role to healthcare insurers. The insurers are responsible for ensuring efficiency and quality, rather than the government. Despite the reforms, affordability continues to require attention. We have seen an increase in waiting times which may indicate a capacity shortage, but also a lack of coordination across the sector and between the hospital sector and primary care services. As in many countries, the rising cost of (new) drugs is a problem.
Isabelle Durand-Zaleski and Johan van Manen
The general goals of the French healthcare system are: full coverage, access without waiting lists and patient choice and satisfaction. Recent reforms have aimed to improve governance and increase transparency in the system, to contain expenditure without diminishing equity in access, and to improve geographical equity in access to care. The central government plays an important role in defining policy and has been increasingly involved in containing expenditure. Although the system was originally based on the Bismarck model of social insurance, France has moved towards a more centrally organized single-payer model. France has universal and compulsory coverage of healthcare costs for all residents. Coverage is provided by non-competitive social health insurance. Voluntary complementary insurance is available, offered mainly by not-for-profit mutual associations or provident institutions. 95 per cent of residents are covered through employers or vouchers. Private for-profit insurers offer complementary coverage for a limited list of services.
Jos Boertjens, Johan van Manen, Misja Mikkers and Wolf Sauter
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).