Health care systems in eight countries: trends and challenges PREPARED BY THE European Observatory on Health Care Systems April 2002 Health care systems in eight countries: trends and challenges Commissioned by the Health Trends Review, HM Treasury Prepared by the European Observatory on Health Care Systems April 2002 The European Observatory on Health Care Systems is a unique project that builds on the commitment of all its partners to improving health care systems: S The World Health Organization Regional Office for Europe S Government of Greece S Government of Norway S Government of Spain S European Investment Bank S Open Society Institute S World Bank S London School of Economics and Political Science S London School of Hygiene & Tropical Medicine Health care systems in eight countries: trends and challenges Editors: Anna Dixon Elias Mossialos Authors: Reinhard Busse Anna Dixon Judith Healy Allan Krasnik Sandra Leon Valérie Paris Dominique Polton Ana Rico Ray Robinson Simone Sandier Sarah Thomson Signild Vallgårda Karsten Vrangbæk The European Observatory on Health Care Systems London School of Economics & Political Science Hub Houghton Street London WC2A 2AE UK First published 2002. © The London School of Economics & Political Science 2002 The views expressed in this publication are those of the editors and contributors and do not necessarily represent the decisions or the stated policy of the participating organisations of the European Observatory on Health Care Systems. All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this publication may be reprinted, reproduced or utilised in any form or by any electronic, mechanical or other means, now known or hereafter invented, including photocopying and recording, or in any other information storage or retrieval system, without the prior written permission of the copyright holder. A catalogue record for this publication is available from the British Library. ISBN 0 7530 1548 X Table of Contents Introduction 1 Australia 3 Denmark 17 France 31 Germany 47 The Netherlands 61 New Zealand 75 Sweden 91 The United Kingdom 103 Appendix 115 Glossary 122 i List of Tables Table 1.1 Main sources of health care funding in Australia, as a percentage of total expenditure, 1979/1980–1999/2000 Table 1.2 Trends in health care expenditure in Australia, 1970–2000 Table 1.3 Government and non-government expenditure as a percentage of total expenditure on health services, 1985/1986 to 1999/2000 (current prices, per cent) Table 1.4 Inpatient utilisation and performance in Australia, 1970–1997 Table 2.1 Main sources of funding for county and municipal expenditure in Denmark, in billion DKK and as a percentage of total, 2001 Table 2.2 Main sources of health care funding in Denmark, as percentage of total and percentage of GDP, 1999 Table 2.3 Health care expenditure by type of service in Denmark, current prices in million DKK, 1980-1999 Table 2.4 Summary of key reforms in Denmark, recent years Table 3.1 Level of complementary VHI coverage in France, as a percentage of total, 2000 Table 3.2 Social health insurance contributions in France Table 3.3 Market share of the three types of insurer offering complementary VHI in France (CMU excluded) Table 3.4 Main sources of health care funding in France, in million EUR and as a percentage of total, 2000 Table 3.5 Health care expenditure by type of service in France, million EUR and as a percentage of total, 2000 Table 3.6 Health care personnel France, 2000 Table 4.1 Trends in health care expenditure in Germany, 1992–1998 Table 4.2 Main sources of health care funding in Germany, as a percentage of total, 1992 and 1998 Table 4.3 Health care expenditure by type of service and provider in Germany, as a percentage of total, 1992 and 1998 Table 4.4 Structure and utilisation data on general and psychiatric hospitals in western and eastern parts of Germany, 1991–1998 Table 4.5 Ownership of German general hospitals, 1990-1999 Table 4.6 Proportion of patients reporting problems with hospital care, in Germany, Sweden, Switzerland, UK and US, 1998-2000 Table 5.1 The changing mix of payments to sickness funds in the Netherlands, 1992-1999 Table 5.2 Trends in health care expenditure in the Netherlands, 1980-2000 Table 5.3 Main sources of health care funding in the Netherlands, as a percentage of total, 1980-1999 Table 5.4 Health care expenditure by type of service in the Netherlands, in 1000 million NLG and as a percentage of total, 1990-2000 Table 5.5 Inpatient utilisation and performance in the Netherlands, 1980-1998 ii Table 6.1 Main sources of health care funding in New Zealand as a percentage of total, 1980- 1999 Table 6.2 Health care expenditure, Consumer Price Index (CPI) deflated trends Table 6.3 Health care expenditure by type of service, as percentage of total expenditure on health, 1990-97 Table 6.4 Health care personnel in New Zealand, per 1000 population, 1990, 1995 and 2000 Table 7.1 Cost of prescribed drugs and associated coinsurance rates in Sweden Table 7.2 Trends in health care expenditure in Sweden, 1980-1998 Table 7.3 Length of wait for consultation and length of consultation in primary care in Spain, Finland, Portugal and Sweden, 1997 Table 8.1 Trends in health care expenditure in the United Kingdom, 1980-1999 Table 8.2 Main sources of health care funding in the United Kingdom, as percentage of total expenditure, 1980-1999 Table A1 Expenditure on health in selected countries, 1988 and 1999 or latest available year (LAY) Table A2. Expenditure on health by source of funding in selected countries (percentage of total expenditure on health) 1999 or latest available year Table A3. At a glance: important characteristics of health care systems in selected countries relating to financing, 2000 (unless noted) Table A4. User charges for different health care services in selected countries, 2001 unless specified iii List of contributors Reinhard Busse is Professor and Director of the Department for Health Care Management at the Technical University Berlin and Associate Research Director of the European Observatory on Health Care Systems. Anna Dixon is Lecturer in European Health Policy in the Department of Social Policy, London School of Economics and Political Science and Research Associate with the European Observatory on Health Care Systems. Judith Healy Formerly Senior Research Fellow, European Observatory on Health Care Systems, based at the London School of Hygiene & Tropical Medicine. Currently Visiting Fellow at the National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia. Allan Krasnik is Professor at the Institute of Public Health, University of Copenhagen Sandra Leon is Research Assistant at the European Observatory on Health Care Systems, Madrid Hub Elias Mossialos is Brian Abel-Smith Reader in Health Policy, London School of Economics and Political Science and Research Director of the European Observatory on Health Care Systems Valérie Paris is Researcher at the Centre de recherche, d'études et de documentaton en économie de la santé (CREDES), Paris Dominique Polton is Director of the Centre de recherche, d'études et de documentaton en économie de la santé (CREDES), Paris Ana Rico is Research Fellow at European Observatory on Health Care Systems, Madrid Hub Ray Robinson is Professor of Health Policy, LSE Health and Social Care, London School of Economics and Political Science Simone Sandier is Research Director of Arguments Socio-Economiques pour la Santé, Paris. Sarah Thomson is Research Associate in Health Policy at LSE Health and Social Care, London School of Economics and Political Science and Research Officer with the European Observatory on Health Care Systems. Signild Vallgårda is Associate Professor at the Institute of Public Health, University of Copenhagen Karsten Vrangbæk is Assistant Professor at the Institute of Public Health and Institute of Political Science, University of Copenhagen iv Acknowledgements The editors would like to thank Anna Maresso for her editorial assistance and Demetra Nicolaou for administrative assistance. The production of this report would not have been possible without the work already undertaken for the European Observatory on Health Care Systems by the authors of the Health Care Systems in Transition series. v Abbreviations Monetary values are generally given in national currency units. The abbreviations used in the text and the current exchange rates (GBP1= at 1st January 2002) are listed here for reference. Australia AUD Australian dollar 2.85 Denmark DKK Danish krone 12.13 France EUR euro 1.63 Germany EUR euro 1.63 (DEM German mark 3.20) The Netherlands EUR euro 1.63 (NLG Dutch guilder 3.60) New Zealand NZD New Zealand dollar 3.50 Sweden SEK Swedish krona 15.20 UK GBP British pound 1.00 USA USD American dollar 1.45 vi INTRODUCTION In March 2001, the Chancellor of the Exchequer asked Derek Wanless to undertake a review of the drivers of health care expenditure in the United Kingdom and their likely impact on the resources required for the health service over the next 20 years. In deliberating the appropriate response to these pressures it is useful to see how countries outside the United Kingdom are addressing these challenges. This report, commissioned by the Health Trends Review at HM Treasury, aims to provide up-to-date information on the health care systems of seven countries outside the UK. It also includes a report on the UK health care system as a point of comparison. The report has been compiled by the European Observatory on Health Care Systems. The Observatory is a project that builds on the commitment of all its partners to improving health care systems. The material used in compiling this report draws heavily on the Observatory’s Health Care Systems in Transition profiles for the relevant countries.