COMPETITION IN CONTEXT - THE POLITICS OF HEALTH-CARE REFORM IN EUROPE

Authors
Citation
R. Freeman, COMPETITION IN CONTEXT - THE POLITICS OF HEALTH-CARE REFORM IN EUROPE, International journal for quality in health care, 10(5), 1998, pp. 395-401
Citations number
29
Categorie Soggetti
Heath Policy & Services
ISSN journal
13534505
Volume
10
Issue
5
Year of publication
1998
Pages
395 - 401
Database
ISI
SICI code
1353-4505(1998)10:5<395:CIC-TP>2.0.ZU;2-W
Abstract
The purpose of this paper is to provide a basis for exploring the rela tionship between competition and quality in health care by delineating the different institutional, economic and political contexts in which pro-competitive reform was conceived and carried out in different Eur opean countries. It begins by distinguishing between national health s ervices and social insurance systems, suggesting that different kinds of system generate different kinds of problem. Different patterns of r eform in Italy, Sweden and the UK, and in France and Germany are then reviewed in turn. The paper shows how, since the end of the long boom, health systems in Europe have been exposed to a set of economic, poli tical and ideological pressures. The way these were brought to bear me ant that governments in those countries with national health services were much more disposed to radical, pro-competitive reform than others . For them, competition represented a way of managing resource constra int in an increasingly complex and demanding political environment; id eas about quality were marginal to their purpose. The paper then explo res the application of competition in different contexts, first among providers and then among purchasers, for which the UK and Germany serv e as examples in turn. In each case, competition is only made effectiv e by new forms of managerial direction. Across systems, competition ar rears less clearly associated with quality than with political control .