Zusammenfassung
Wettbewerb und Privatisierung sollen die Gesundheitssysteme effizienter und kundenorientierter machen. Ausgehend von der Wohlfahrtsstaatenforschung, die Gesundheit bisher vernachlässigt hat, untersucht dieses Buch, ob und wie weit Marktelemente in die Gesundheitssysteme der Niederlande, Deutschland und Schwedens eingebaut wurden.
Die Analyse zeigt, dass trotz des gleichen Problemdrucks – demographischer Wandel, medizinisch-technische Innovationen, Staatsverschuldung – die Marktidee durch die nationalen Ideen und Institutionen anders umgesetzt wurde. Während Deutschland und die Niederlande Wettbewerb zwischen den Krankenversicherungen einführten, setzte Schweden auf Wettbewerb zwischen den Ärzten.
Eine gesonderte Analyse des Einflusses der Europäischen Union auf die nationalen Reformen zeigt, dass die Offene Methode der Koordinierung im Bereich Gesundheit und Langzeitpflege kein Vorbild propagierte und damit auch keinen weichen Einfluß ausüben konnte. Obwohl die EU eigentlich keine Kompetenz für die sozialen Sicherungssysteme besitzt, hatten der Binnenmarkt und die Marktfreiheiten mehr Einfluß als die OMK.
Abstract
Wettbewerb und Privatisierung sollen die Gesundheitssysteme effizienter und kundenorientierter machen. Ausgehend von der Wohlfahrtsstaatenforschung, die Gesundheit bisher vernachlässigt hat, untersucht dieses Buch, ob und wie weit Marktelemente in die Gesundheitssysteme der Niederlande, Deutschland und Schwedens eingebaut wurden.
Die Analyse zeigt, dass trotz des gleichen Problemdrucks – demographischer Wandel, medizinisch-technische Innovationen, Staatsverschuldung – die Marktidee durch die nationalen Ideen und Institutionen anders umgesetzt wurde. Während Deutschland und die Niederlande Wettbewerb zwischen den Krankenversicherungen einführten, setzte Schweden auf Wettbewerb zwischen den Ärzten.
Eine gesonderte Analyse des Einflusses der Europäischen Union auf die nationalen Reformen zeigt, dass die Offene Methode der Koordinierung im Bereich Gesundheit und Langzeitpflege kein Vorbild propagierte und damit auch keinen weichen Einfluß ausüben konnte. Obwohl die EU eigentlich keine Kompetenz für die sozialen Sicherungssysteme besitzt, hatten der Binnenmarkt und die Marktfreiheiten mehr Einfluß als die OMK.
- Kapitel Ausklappen | EinklappenSeiten
- 13–14 List of Figures 13–14
- 17–24 1. Introduction 17–24
- 17–20 1.1 Scope 17–20
- 21–22 1.3 Data sources 21–22
- 22–24 1.4 Outline 22–24
- 25–30 2.1 Structuralism 25–30
- 75–88 4. Methodology 75–88
- 77–79 4.2.1 Governance 77–79
- 79–81 4.2.2 Funding 79–81
- 81–82 4.2.3 Provision 81–82
- 82–84 4.2.4 Remuneration 82–84
- 84–86 4.2.4 Access 84–86
- 89–148 5. The Netherlands 89–148
- 93–100 5.2 Institutions 93–100
- 100–101 5.3 Discourse 100–101
- 101–110 5.4 Change 101–110
- 110–117 5.5 Governance 110–117
- 110–113 5.5.1 Competition 110–113
- 116–117 5.5.4 Liability 116–117
- 117–120 5.6.1 AWBZ 117–120
- 120–126 5.6.2 Second compartment 120–126
- 127–130 5.6.4 Summery funding 127–130
- 130–133 5.7.1 Ambulatory care 130–133
- 133–135 5.7.2 Stationary care 133–135
- 135–136 5.7.3 Pharmaceuticals 135–136
- 136–137 5.7.4 Dental care 136–137
- 137–140 5.8 Access and equality 137–140
- 139–140 5.8.2 Inequality 139–140
- 140–146 5.9 Conclusion change 140–146
- 143–143 5.9.2 Institutions 143–143
- 143–145 5.9.3 Market idea 143–145
- 145–146 5.9.4 Europeanization 145–146
- 146–148 5.10 Final Conclusion 146–148
- 149–210 6. Sweden 149–210
- 149–152 6.1 Structural factors 149–152
- 152–160 6.2 Institutions 152–160
- 155–156 6.2.2 Welfare State 155–156
- 160–163 6.3 Discourse 160–163
- 163–165 6.4 Change 163–165
- 165–173 6.5 Governance 165–173
- 165–166 6.5.1 Devolution 165–166
- 166–168 6.5.2 National framework 166–168
- 173–182 6.6 Funding 173–182
- 173–180 6.6.1 Devolution 173–180
- 181–182 6.6.3 Conclusion Funding 181–182
- 182–201 6.7 Provision 182–201
- 182–188 6.7.1 Devolution 182–188
- 188–196 6.7.2 Privatisation 188–196
- 196–196 6.7.3 Public Health 196–196
- 196–198 6.7.4 Dental care 196–198
- 198–200 6.7.5 Pharmaceuticals 198–200
- 201–206 6.8 Access and equality 201–206
- 201–204 6.8.1 Waiting lists 201–204
- 204–204 6.8.2 Prioritization 204–204
- 204–205 6.8.3 Co-payments 204–205
- 205–206 6.8.4 Inequality 205–206
- 206–206 6.8.5 Conclusion access 206–206
- 206–210 6.9 Conclusion change 206–210
- 209–210 6.9.3 Market Idea 209–210
- 210–210 6.10 Final conclusion 210–210
- 211–278 7. Germany 211–278
- 211–213 7.2 Structural factors 211–213
- 213–221 7.2 Institutions 213–221
- 221–229 7.3 Discourse 221–229
- 221–227 7.3.1 Reform discourse 221–227
- 227–227 7.3.2 Other actors 227–227
- 227–228 7.3.3 Private Insurances 227–228
- 229–230 7.4 Change 229–230
- 230–243 7.5 Governance 230–243
- 230–238 7.5.1 Social Insurances 230–238
- 238–241 7.5.2 Private Insurances 238–241
- 242–242 7.5.4 Liability 242–242
- 243–257 7.6 Funding 243–257
- 243–249 7.6.1 Social Insurances 243–249
- 252–253 7.6.4 Civil servants 252–253
- 253–253 7.6.5 Uninsured 253–253
- 255–257 7.6.8 Conclusion funding 255–257
- 257–261 7.7.1 Ambulatory care 257–261
- 261–266 7.7.2 Hospitals 261–266
- 267–267 7.7.4 Dental care 267–267
- 267–269 7.7.5 Pharmaceuticals 267–269
- 271–274 7.8 Access and equality 271–274
- 271–273 7.8.1 Benefit package 271–273
- 273–273 7.8.2 Inequality 273–273
- 273–274 7.8.3 Conclusion Access 273–274
- 274–278 7.9 Conclusion 274–278
- 277–278 7.9.3 Market idea 277–278
- 278–278 7.9.4 Europeanization 278–278
- 278–278 7.10 Final conclusion 278–278
- 279–287 8.1 Competition 279–287
- 285–286 8.1.5 Pharmaceuticals 285–286
- 287–291 8.2 Privatization 287–291
- 287–288 8.2.1 Provision 287–288
- 288–290 8.2.2 Funding 288–290
- 291–296 8.3 Assessment 291–296
- 293–294 8.3.2 Solidarity 293–294
- 299–302 9.1 Mediated problems 299–302
- 302–303 9.2 Adapted solutions 302–303
- 305–307 9.5 Impact of the EU 305–307
- 307–308 9.6 Welfare state theory 307–308
- 308–310 9.7 Overall conclusion 308–310
- 311–328 Biobliography 311–328
58 Treffer gefunden
- „... 16 Swedish abbreviations and terms V Vänsterpartiet left Party, former Communist party KD ...” „... Kommuner och Landsting Swedish Association of Local Authorities and Regions C Centerpartiet Centre Party FP ...” „... Labour Party of Sweden M Moderata samlingspartiet Moderates Skr Svensk Krona Swedish Crown German ...”
- „... 207 Councils summarizing the changes and challenges of the 1990s (Federation of Swedish County ...” „... pattern. Hence, the explanation of the Swedish reform path is found in institutions and ideas, while the ...” „... Swedish population is aging, but at the same time surgeries are not consumed more often, just later in ...”
- „... , & Martinussen, 2009). During the course of the 90s, the ideal Swedish welfare state experienced major reforms ...” „... (OECD). Equity is at the heart of the Swedish welfare state, resulting in a low Gini coefficient. The ...” „... competitiveness of Swedish industrial products sunk. In the early 90s, the worldwide economy slowed down and ...”
- „... heart of the Swedish welfare state. The political institutions of the counties have no veto-points, and ...” „... in particular their high number of employees. The Swedish county-based public health service is a ...” „... , perhaps this reform-ability is even an inherent characteristic of the Swedish health care model. The ...”
- „... , the delineation between health care and care for the elderly is quite simple in the Swedish system, as ...” „... comparison, Swedish nurses and midwifes have far-reaching competences. Within a limited framework they can ...” „... (Federation of Swedish County Councils, 2002). Increasing quality of life comes at a price. Another reason is ...”
- „... by the parliament and therefore a member of the governing party. Since 1971, the Swedish parliament ...” „... September. This makes the Swedish political system unique, as voting turnouts at the different levels are ...” „... number of veto points, Swedish politics are characterised by consent, negotiations and compromise ...”
- „... . Enthoven even published a special paper, in which he adopted his ideas to the Swedish model (Enthoven, 1989 ...” „... and in particular the public services as “wasteful, overly bureaucratic and depriving the Swedish ...” „... rendered Swedish products uncompetitive on the world markets. The ideas of Reagan and Thatcher also ...”
- „... majority of the generous Swedish social services is delivered and administered at the local level: child ...” „... State The aim of the Swedish welfare state is to prevent income losses in times of retirement, sickness ...” „... the annual GDP. An erosion of the Swedish model has been diagnosed since the 90s. Sweden decreased ...”
- „... adopt its policies, to maintain equal access to high quality care. 6.9 Conclusion change The Swedish ...” „... summarizing the changes and challenges of the 1990s (Federation of Swedish County Councils, 2002). These are ...” „... explanation of the Swedish reform path is found in institutions and ideas, while the impact of the European ...”
- „... : Palgrave Macmillan. Anell, A. (2005). Swedish Health Care under Pressure. Health Economics, 14(S1), 273-254 ...” „... . (2004). The Choice Revolution: Privatization of Swedish Welfare Services in the 1990s. Social Policy ...” „... www.kiesBeter.nl. Chapter 1: Background to the new Swedish public health policy (2004). Scandinavian Journal of ...”
- „... approaches. The process cumulated in the creation of the Swedish Association of Local Authorities and Regions ...” „... (SALAR) in 2007. Prior, the county councils were represented in two bodies: the Swedish Association of ...” „... (Swedish Association of Local Authorities and Regions, 2008b). Furthermore, they worked out a patient ...”
- „... the 80s, the Swedish universal welfare state had reached its climax and so had health care ...” „... result of economics of scale 57 1 Swedish Crown ...” „... equal level of services that should be provided in the Swedish welfare state. Income equalisation has ...”
- „... international contacts. ("Chapter 1: Background to the new Swedish public health policy", 2004, pp. Background ...” „... . The process cumulated in the creation of the Swedish Association of Local Authorities and Regions ...” „... (SALAR) in 2007. Prior, the county councils were represented in two bodies: the Swedish Association of ...”
- „... in the tax-funded Swedish system. The countries are converging. Sweden reduced the redistribution in ...” „... improve the re-distribution between the counties. Hence, risk-equalization also strengthened the Swedish ...” „... themselves mainly provide information on new pharmaceuticals. The institutional structure of the Swedish ...”
- „... the new value of self-determination. Post-modern individualism also found its way into the Swedish ...” „... traditional health care system. The principle value of universalism has never been challenged in the Swedish ...” „... the Swedish welfare state. However, it was sided by freedom (of choice). The dominating neo-liberal ...”
- „... demand. The same result could be observed for Swedish ambulatory care. Countries that introduced private ...” „... expenditures. General economic developments, like the Swedish economic crisis in the early 90s, and the Dutch ...” „... in the tax-funded Swedish system. The countries are converging. Sweden reduced the redistribution in ...”
- „... hospital, primary care and the municipality care (Federation of Swedish County Councils, 2002). It has been ...” „... dominating issues in the Swedish reform debate. Before assessing their scope, a clear classification of the ...” „... (Federation of Swedish County Councils, 2002). Graphic 4 shows the increase of private personnel, including ...”
- „... 16 Swedish abbreviations and terms V Vänsterpartiet left Party, former Communist party KD ...” „... Kommuner och Landsting Swedish Association of Local Authorities and Regions C Centerpartiet Centre Party FP ...” „... Labour Party of Sweden M Moderata samlingspartiet Moderates Skr Svensk Krona Swedish Crown German ...”
- „... Insurers ZVW Zorgverzekeringswet Health Insurance Law gemoedsbezwaarden Religious objectors 16 Swedish ...” „... Swedish Association of Local Authorities and Regions C Centerpartiet Centre Party FP Folkpartiet ...” „... Party of Sweden M Moderata samlingspartiet Moderates Skr Svensk Krona Swedish Crown German abbreviations ...”
- „... accessibility and responsiveness in the public system (own calcutions based on: Swedish Association of Local ...” „... is not solved within the public system. In the Swedish struggle to cut down waiting times, many ...” „... placed prioritization on the agenda in 1987. In the same year, the Swedish Scientific Assessment of ...”
- „... waiting for care, paying for care, and distance to care. In 2006, 15.3% of the Swedish respondents ...” „... sector. 286 successful for generics. The Swedish method results in overall lowest prices, also for ...” „... severe undersupply. Hence, introducing competition in the single-payer Swedish system was more ...”
- „... , the Swedish Scientific Assessment of Health Technology (Statens beredning för medicinsk utvärdering ...” „... 100 Swedish Crowns are 11 Euros. 205 early 90s, these were 1800 Skr for all goods and services. Since ...” „... population. Data on gaps in life expectancy are only available until 1996. Despite the Swedish concern with ...”
- „... available starting from 1993; they show a rise from 10.7% to 13.8%. However, Swedish policy responses are ...” „... countries. In the heights of the Swedish public health service, even in this sector of provision, governance ...” „... responsiveness in the public system (own calcutions based on: Swedish Association of Local Authorities and ...”
- „... Germany, one-third of hospitals were private nonprofits. Even in the Swedish NHS, around 20 private ...” „... only introduced in 1997. Besides the co-payments, public budgets finance the Swedish system almost ...” „... services can be excluded from the public system. The Swedish health care system was always universal. The ...”
- „... . 05001000150020002500300035001990199119921993199419951996199719981999200020012002200320042005200620072008Euro 2000 PPP050001000015000200002500030000Swedish Crowns 2000 PPPGermany Netherlands Sweden293 The ...” „... result could be observed for Swedish ambulatory care. Countries that introduced private providers and ...” „... . General economic developments, like the Swedish economic crisis in the early 90s, and the Dutch boom in ...”
- „... . As the German system is much older, than the Swedish and the Dutch one, it is most resistant to ...” „... , instability marks the Swedish health care reforms, like the stop-and-start laws and the family doctor reform ...” „... Swedish egalitarian values. The outsourcing of dental care became a sensitive topic in political debates ...”
- „... out of the total health care expenditures are contradicting. While the Federation of Swedish County ...” „... figures are only available starting from 1993; they show a rise from 10.7% to 13.8%. However, Swedish ...” „... private market elements in most countries. In the heights of the Swedish public health service, even in ...”
- „... already established, whereas it called for fundamental reforms in the Swedish system. The Dutch family ...” „... universality became new values. The Swedish society had never been as hierarchical and equality was the ...” „... the tax-based Swedish system. 302 Graphic 21: Total health care expenditures as share of gross ...”
- „... based on a fee-schedule that applied to all. Such a fee schedule also existed for Swedish dentists. In ...” „... , private duplicate insurances emerged on the Swedish market as a result of policy drift. They offered the ...” „... ambulatory care in the more densely populated counties. Due to the monopoly position of the Swedish county ...”
- „... a pressure for reform. Universal solidarity was and is the central value of the Swedish welfare ...” „... age. The idea was translated by Alain Enthoven to health care and adapted to the Swedish system. The ...”
- „... , the Swedish Scientific Assessment of Health Technology (Statens beredning för medicinsk utvärdering ...” „... 100 Swedish Crowns are 11 Euros. ...”
- „... 286 successful for generics. The Swedish method results in overall lowest prices, also for ...” „... severe undersupply. Hence, introducing competition in the single-payer Swedish system was more ...”
- „... the purest state system in Western Europe. The Swedish state did not introduce market instruments to ...” „... privatization. The Swedish system is still characterised by public planning, tax-funding and public providers ...”
- „... between health care and care for the elderly is quite simple in the Swedish system, as the municipalities ...” „... , Swedish nurses and midwifes have far-reaching competences. Within a limited framework they can prescribe ...”
- „... problem. Demand steering should increase responsiveness and quality. The old Swedish systems were ...” „... waiting for care, paying for care, and distance to care. In 2006, 15.3% of the Swedish respondents ...”
- „... life expectancy are only available until 1996. Despite the Swedish concern with health inequalities ...” „... adopt its policies, to maintain equal access to high quality care. 6.9 Conclusion change The Swedish ...”
- „... been not used yet. Very few patients use crossborder care. The ECJ skipped the Swedish state monopoly ...” „... Swedish market. This freedom of establishment cannot be limited by national governance, even if a majority ...”
- „... . This is often presented as “money follows the patient” but does not have to be the case. The Swedish ...” „... the discourse. Dalarna was the reference model of the Swedish purchaser-provider split. However ...”
- „... : Composition of Swedish governments ............................................. 153 Table 8: Health care ...”
- „... adopt its policies, to maintain equal access to high quality care. 6.9 Conclusion change The Swedish ...”
- „... system. The Swedish health care system was always universal. The Netherlands and Germany included the ...”
- „... , and the Swedish regions provide national statistics that are more detailed and up to date. Furthermore ...”
- „... 196 6.7.3 Public Health Health prevention and promotion plays a central role in Swedish health care ...”
- „... statistical offices, health care insurances, medical associations, and the Swedish regions provide national ...”
- „... system. The Swedish health care system was always universal. The Netherlands and Germany included the ...”
- „... Growth Sweden Data Source: (OECD, 2010) At the beginning of the 80s, the Swedish universal welfare state ...”
- „... pillarization. In Germany, one-third of hospitals were private nonprofits. Even in the Swedish NHS, around 20 ...”
- „... . Institutional inertia accumulates over time. As the German system is much older, than the Swedish and the Dutch ...”
- „... self-administration or network governance. Swedish health care governance is dominated by the state with a fragile ...”
- „... reform path. Whereas equality was the central value in Swedish social policy, the Netherlands praised ...”
- „... . The old Swedish systems were particularly bureaucratic and had long waiting lists. Since 2005 ...”
- „... ambulatory care in the more densely populated counties. Due to the monopoly position of the Swedish county ...”
- „... self-administration or network governance. Swedish health care governance is dominated by the state with a fragile ...”
- „... 196 6.7.3 Public Health Health prevention and promotion plays a central role in Swedish health care ...”
- „... has been positively evaluated, and the Swedish quality registers are mentioned as a best-practice ...”
- „... resembled the Swedish system, although administered at the central level. Ambulatory health care was ...”
- „... Nordic countries should serve as an example. Hence, this study takes the Swedish national health service ...”
- „... abbreviations and terms 15 Swedish abbreviations and terms 16 German abbreviations and terms 16 1 ...”