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| Title |
Explaining Health Care System Change:
Problem Pressure and the Emergence of
“Hybrid” Health Care Systems |
| Author(s) |
Achim Schmid,Mirella Cacace,Ralf Götze, and Heinz Rothgang - Personal Name
|
Subject |
Health System and Policy |
| Publisher |
Duke University Press |
| Publishing Year |
2010 |
| Specific Detail Info |
In this article, we will further the explanation of the state’s changing role
in health care systems belonging to the Organisation for Economic Co-operation
and
Development (OECD). We build on our analysis of twenty-three
OECD countries,
which reveals broad trends regarding governments’ role in financing, service provision,
and regulation. In particular, we identified increasing similarities between the
three system types we delineate as National Health Service (NHS), social health
insurance, and private health insurance systems. We argue that the specific health care
system type is an essential contributor to these changes. We highlight that health care
systems tend to feature specific, type-related
deficiencies, which cannot be solved by
routine mechanisms. As a consequence, non-system-
specific
elements and innovative
policies are implemented, which leads to the emergence of “hybrid” systems and
indicates a trend toward convergence, or increasing similarities.
We elaborate this hypothesis in two steps. First, we describe system-specific
deficits of each health care system type and provide an overview of major adaptive
responses to these deficits. The adaptive responses can be considered as non-system-
specific
interventions that broaden the portfolio of regulatory policies. Second, we
examine diagnosis-related
groups (DRGs) as a common approach for financing
hospitals efficiently, which are nevertheless shaped by type-specific
deficiencies
and reform requirements. In the United States’ private insurance system, DRGs are
mainly used as a means of hierarchical cost control, while their implementation in
the English NHS system is to increase productivity of hospital services. In the German
social health insurance system, DRGs support competition as a means to control self-regulated
providers. Thus, DRGs contribute to the hybridization of health
care systems because they tend to strengthen coordination mechanisms that were less
developed in the existing health care systems. |
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