Claus Wendt, Jürgen Kohl, Theresa Thompson
Modes of Regulation and their Effects on Financing and Service Provision in OECD Health Care Systems
In this paper, changing modes of regulation (hierarchy, self-regulation, and market) in health care systems are analyzed as well as how these changes affect health care financing and health care provision. The study shows that modes of regulation in different types of health care systems become more similar, for example with respect to the level of coverage, type of remuneration, the access of service providers to the health care market, or the benefit package. The empirical analysis of financing and service provision demonstrates that the mode of regulation matters above all with regard to the level of health care financing. Market-based systems as in the US show the highest level and the most dramatic increase of total health expenditure, SHI (social health insurance) systems as in Germany show also major problems in stabilizing costs while NHS (national health service) systems as in the United Kingdom proved to be most successful in keeping relative health expenditures in check. Comparing an index of health care provision with the level of health care expenditure, we find only a weak correlation. While some countries are able to provide an above average package of health care services with below average health care spending, some high spending countries are only able to offer a benefit package at or below the OECD average. Different modes of regulation can help to explain why some countries were more successful in translating monetary inputs in a high level of health care services than other countries.