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Health-Care Systems: Lessons from the Reform Experience

Elizabeth Docteur

Elizabeth Docteur Consulting

Howard Oxley

Organization for Economic Co-Operation and Development (OECD) - Economics Department (ECO)

December 10, 2003

OECD Health Working Papers No. 9
OECD Economics Department Working Papers No. 374

This study presents a broad overview of health-system reforms in OECD countries over the past several decades. Reforms are assessed according to their impact on the following policy goals: ensuring access to needed health-care services; improving the quality of health care and its outcomes; allocating an "appropriate" level of pubic sector and economy-wide resources to health care (macroeconomic efficiency); and ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomic efficiency).While nearly all OECD countries have achieved universal coverage of health-care risks, initiatives to address persistent disparities in access are now being undertaken in a number of countries. In light of new evidence of serious problems with health-care quality, many countries have recently introduced reforms intended to improve this, but it is too soon to generalise as to the relative effects of alternative approaches. A variety of instruments aimed at cost control have succeeded in slowing the growth of (particularly public) health-care spending over the 1980s and 1990s but these have not addressed
the root causes of growth and health-care spending continues to rise as a share of GDP in most countries. On the other hand, a few countries have been concerned that spending restrictions have gone too far and hurt health system-performance. There is some evidence that supply of health services has become more efficient, particularly in the hospital sector, but scope for further gains exists. A range of measures, such as better payment methods, have improved the microeconomic incentives facing providers. However,introducing improved incentives through a more competitive environment among providers and insurers has proved difficult.

Number of Pages in PDF File: 98

Keywords: health system reform, OECD, efficiency, cost-containment

JEL Classification: I10, I11 and I18

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Date posted: January 18, 2009  

Suggested Citation

Docteur, Elizabeth and Oxley, Howard, Health-Care Systems: Lessons from the Reform Experience (December 10, 2003). OECD Economics Department Working Papers No. 374; OECD Economics Department Working Papers No. 374. Available at SSRN: http://ssrn.com/abstract=1329305 or http://dx.doi.org/10.2139/ssrn.1329305

Contact Information

Elizabeth Docteur (Contact Author)
Elizabeth Docteur Consulting ( email )
633 S. Saint Asaph Street
Washington, DC 22314-4118
United States
Howard Oxley
Organization for Economic Co-Operation and Development (OECD) - Economics Department (ECO) ( email )
2 rue Andre Pascal
Paris Cedex 16, MO 63108
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