purpose of comparative analysis
- gain perspective
-generate causal explanations - draw policy lessons
policies can be
- promising and feasible
- promising and not feasible
- feasible but not promising
commonalities between Canada, US and EU and differences
- high total health expenditure
- high level of gov expenditures
- independence and power of key actors
- financing methods
admin and regulatory mechanisms
delivery systems - degree and depth of universal health coverage
typology based on financing
social health insurance system = bismarck
national health service and national health insurance - beveridge
private health insurance system
semashko
beveridge model
- includes entire pop
- from general tax revenue
- calls for uniform, lump sum contributions
Bismarck model
-insured persons are employees/employed
- financing via contributions
- contributions to be paid are based on wages or salaries
key difference with Bismarck and beveridge
Bismarck leads to no redistribution between various income groups, but beveridge does
private health insurance model
- relies on sophisticated insurance market for health goods and services
limitations of this typology
- every OECD will have varying mixture of all through systems
Bohm typology (include regulation, financing, service delivery)
national health service, national health insurance, etatist social health insurance, social health insurance, private health insurance
What do we compare?
- population health
- health services outcome
- patient experience
- financial protection
- equity
- productivity/cost effectiveness
what are direct measures
health system is central locusof control of outcome
what are indirect measures
health system is one of many inputs that affect an outcome
germany model
- Bismarck/social health insurance
Japan model
- statist social health insurance
England model
beveridge/national health service
US model
private health insurance
where is Canada in health care system performance rankings and takeaways
- below average
- no immediate relationship between model of healthcare and overall performance
- caution when comparing overall performance
where is Canada in health care spending as a percentage of GDP
- about average
where does Canada lie in affording health care
below average… even though medicare, so many things aren’t covered
countries with the strongest systems
- provide universal coverage
- invest in primary care systems
- reduce administrative burdens
- invest in social services
Canadas best performance
care delivery, health outcomes, administrative efficiency
Canada worst performance
access to care and health equity
health system reform dimensions
- number of aspects of health care system changed
- how radically those changes depart from past practise
