European Observatory on Health Systems and Policies Snapshots of Health Systems The state of affairs in 16 countries in summer 2004 edited by Susanne Grosse-Tebbe and Josep Figueras Document number: WHO/EURO:2004-850-40585-54563 © World Health Organization 2004, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about the publications of the European Observatory on Health Sys- tems and Policies to: • by e-mail [email protected] (for copies of publications) [email protected] (for permission to reproduce them) [email protected] (for permission to translate them) • by post Publications WHO Regional Offi ce for Europe Scherfi gsvej 8 DK-2100 Copenhagen Ø, Denmark The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Sys- tems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cit- ies, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages in- curred as a result of its use. 2 Contents Acknowledgements ................................................................................. 4 Austria........................................................................................................ 6 Belgium....................................................................................................11 Denmark ..................................................................................................15 Finland.....................................................................................................18 France ......................................................................................................21 Germany ..................................................................................................25 Greece .....................................................................................................29 Ireland .....................................................................................................33 Israel .......................................................................................................37 Italy ..........................................................................................................41 Luxembourg ...........................................................................................44 The Netherlands.....................................................................................47 Portugal ...................................................................................................50 Spain ........................................................................................................53 Sweden ....................................................................................................56 The United Kingdom of Great Britain and Northern Ireland...........59 3 European Observatory on Health Systems and Policies Acknowledgements The Snapshots of health systems - the state of affairs in 16 countries in summer 2004 provide very brief overviews of the organization and fi nancing of the health systems, the provision of health care as well as de- velopments prior to 1 May 2004 in 15 European Union Member States and Israel. The reports have been written by staff of the European Observatory on Health Systems and Poli- cies, with much appreciated contributions of national experts: Austria: Annette Riesberg with contributions of Reinhard Busse (European Observatory on Health Systems and Policies), Maria Hofmarcher (Institute for Advanced Studies, Vienna) and the Austri- an Federal Institute for Health Care; Belgium: Nadia Jemiai with contributions of Dirk Corens (Centre for Health Economics and Hos- pital Policy, VUB, Brussels); Denmark: Susanne Grosse-Tebbe with contributions of Signild Vallgarda (University of Copenhagen, Copenhagen); Finland: Vaida Bankauskaite with contributions of Jutta Jaervelin (STAKES, Helsinki); France: Sara Allin with contributions of the Ministry of Health and Social Protection, Paris; Germany: Annette Riesberg with contributions of Reinhard Busse (European Observatory on Health Systems and Policies); Greece: Christina Golna with contributions of the Ministry of Health and Social Solidarity, Athens; Ireland: David McDaid with contributions of Eamon O’Shea (National University of Ireland); Israel: Sara Allin and Sarah Thomson with contributions of Bruce Rosen (Brookdale Institute, Je- rusalem); Italy: Susanne Grosse-Tebbe with contributions of Francesco Taroni (Agenzia Sanitaria Regionale, Bologna) and the Ministry of Health, Rome; Luxembourg: Nadia Jemiai with contributions of Michele Wolter (Ministry of Health, Luxem- bourg), Marianne Scholl (Inspection générale de la securité sociale, Luxembourg) and Jean-Paul Juchem (Union of Sickness Funds, Luxembourg); Netherlands: Jonas Schreyoegg with contributions of Peter Achterberg (RIVM, Centre for Public Health Forecasting, Bilthoven) and Lejo van der Heiden (Ministry of Health, Welfare and Sport, The Hague); Portugal: Susanne Grosse-Tebbe and Josep Figueras with contributions of Vaida Bankauskaite (Eu- ropean Observatory on Health Systems and Policies); Spain: Susanne Grosse-Tebbe and Hans Dubois with contributions of Rosa Urbanos (Spanish Ob- servatory on Health Systems, Madrid); Sweden: Hans Dubois with contributions of Catharina Hjortsberg (Swedish Institute for Health Economics, Lund); 4 European Observatory on Health Systems and Policies Acknowledgements United Kingdom: Nadia Jemiai with contributions of David McDaid (European Observatory on Health Systems and Policies and the departments responsible for health of England, Wales and Scotland. The reports were edited by Susanne Grosse-Tebbe and Josep Figueras. The summaries presented also form part of WHO Regional Offi ce for Europe’s Highlights’ series 2004. The European Observatory on Health Systems and Policies is very grateful to the Highlights team of the Division of Evidence and Communication, WHO Regional Offi ce for Europe, especially Anca Dumitrescu and Barbara Legowski for the opportunity to contribute to the project. The snapshots of health systems draw on the Observatory’s Health Care Systems in Transi- tion (HiT) series of published profi les and summaries as well as drafts underway. The HiTs are country based reports providing a comprehensive analytical description of a country’s health system and of reform initiatives in progress or under development. The HiTs form a key ele- ment of the work of the European Observatory on Health Systems and Policies. The Observa- tory is a unique undertaking that brings together the World Health Organization Regional Of- fi ce for Europe, the governments of Belgium, Finland, Greece, Norway, Spain and Sweden, the European Investment Bank, the Open Society Institute, the World Bank as well as the Lon- don School of Economics and Political Science and the London School of Hygiene and Trop- ical Medicine. This partnership supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. The Observatory team is led by Josep Figueras, head of the Secretariat, and the research direc- tors Martin McKee, Elias Mossialos and Richard Saltman. Technical coordination and produc- tion of the reports was managed by Susanne Grosse-Tebbe, with the support of Jo Woodhead and Mary Stewart Burgher (copy editing) and Jesper Rossings (lay out). The reports refl ect the information available in summer 2004. 5 European Observatory on Health Systems and Policies Snapshots of health systems Austria The Federal Ministry of Health and Women is the main policy- maker in health care, responsi- ble for supervising the statuto- groups of unemployed as well as ry health insurance actors and is- asylum seekers). The 26 statuto- suing nationwide regulations for ry health insurance funds are or- example on drug licensing and ganized in the Federation of Aus- pricing. The nine Länder govern- Organizational structure trian Social Security Institutions ments deliver public health serv- of the health system and do not compete with each ices and have strong competenc- The Austrian health system is other since membership is main- es to fi nance and regulate inpa- shaped by statutory health in- ly mandatory and based on occu-