Abstract
As presented in the first chapter, the economic order is a dynamic phe- nomenon with governments alternately moving to the left or to the right side of a continuum between two theoretical extremes. Since 1975, the gov- ernments of the countries of the European Union have pursued policies of moving to the right side of the continuum, increasingly giving power to the market, based on economic arguments (globalization)as well as on ideo- logical arguments (neo-liberalism and the theory of “public choice”). These policies also affect the production and consumption of health care goods and services. This is the theme of the second part of this book.
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References
Chapter 5
See: Saltman, R. B. and Figueras, J., (eds.): European Health Care Reform: Analysis of Current Strategies, World Health Organization, Regional Office for Europe, Copenhagen, 1997, pp. 39–42.
Houtepen and Ter Meulen, quoted in Saltman, R. B. and Dubois, H. F.W.: The Historical and Social Base of Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): Social Health Insurance Systems in Western Europe, European Observatory on Health Systems and Policies Series, Open University Press, 2004, p. 27.
Saltman, R. B. and Dubois, H. F.W.: ibid., chapter 2.
Scrivens, E.: Quality, Risk and Control in Health Care, Open University Press, 2005, p. 2.
Mechanic, D.: Politics, Medicine, and Social Science, John Wiley & Sons, 1974, p. 1.
Evans, R. G., et al., (eds.): Why are Some People Healthy and Others Not? The Determinants of Health of Populations, Aldine de Gruyter, New York, 1994. A well-known example, demonstrating the limited contribution of medicine to the improved health of the population in the 19th century, was provided by McKeown (McKeown, T.: The Role of Medicine, Princeton University Press, 1979). Also see: White, K.: An Introduction to the Sociology of Health and Illness, SAGE Publications, 2002, and Wilkinson, R. G.: ibid. Furthermore, see: Benzeval, M., et al. (eds.): ibid; Graham, H., (ed.): ibid.
Wilkinson, R. G.: ibid., p. 67.
Figueras, J., Saltman, R. B., Busse, R., and Dubois, H. F. W.: Patterns of Performance in Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 83.
See: Lock, K.: Opportunities for Inter-Sectoral Health Improvement in New Member-States—The Case for Health Impact Assessment, in: McKee, M., MacLehose, L., and Nolte, E., (eds.): Health Policy and European Union Enlargement, European Observatory on Health Systems and Policies Series, Open University Press, 2004, pp. 225–239.
Jones, A. and Rice, N.: Using Longitudinal Data to Investigate Socioeconomic Inequality in Health, in: Smith, P. C., Ginelly, L., Sculpher, M., (eds.): Health Policy and Economics: Opportunities and Challenges, Open University Press, 2005, p. 89.
Their activities in health care have been described by many authors. See, for example, (1) Beek, H. H.: De Geestesgestoorde in de Middeleeuwen: Beeld en Bemoeienis, Haarlem, 1969, and (2) Goerke, H.: Arzt und Heilkunde: 3000 Jahre Medizin. Vom Asklepiospriester zum Klinikarzt, Callwey, 1984.
See section 1.2.1. A similar approach can be found in De Vos (Vos, P. de: Hoe Gezond is de Europese Gezondheidspolitiek? in: Materne, L., et al., ibid., pp. 17–22).
Juffermans, P.: Staat en Gezondheidszorg in Nederland, SUN, Nijmegen, 1982, chapter 2. In this book, I do not follow Juffermans, who, based on the ideas of American economist Stevenson, limits the health care domain to the professional activities of doctors, nurses, physiotherapists, et cetera. This approach ignores the fact that developments in the health care process are highly determined by other players. I will go into this in chapter six.
For incrementalism, see, Braybrooke, D. and Lindblom, C. E.: ibid. Walt has summarized the characteristics of incrementalism in five points: (1) a close connection between the objectives and the means of implementation; (2) a small number of alternatives, which differ only marginally from existing policies; (3) only the most important consequences of the alternatives are considered; (4) policy options on which policy makers agree are implemented, irrespective of whether these options would result in optimal outcomes; and (5) the focus is on small changes for the short-term to existing policies, without considering major future changes (Walt, G.: ibid., pp. 48–49).
It seems that Dutch politicians are increasingly trying to bypass the departmental bureaucratic hierarchy to obtain the information they believe to be necessary to fulfil their parliamentary tasks (Nieuwenkamp, R.: De Prijs van het Politieke Primaat: Wederzijds Vertrouwen en Loyaliteit in de Verhouding tussen Bewindspersonen en Ambtelijke Top, Eburon, Delft, 2001).
Busse, R., Saltman, R. B., and Dubois, H. F. W.: Organization and Financing of Social Health Insurance Systems: Current Status and recent Policy Developments, in: Saltman, R. B., Busse, R., Figueras, J., (eds.), ibid., p. 74.
See: Busse, R., Saltman, R. B., and Dubois, H. F.W., (eds.): ibid., pp. 58–60.
American research from 1987 revealed that 91% of the respondents agreed that “everybody should have the right to the best possible healthcare—as good as a millionaire gets” (in: Kuttner, R.: Everything for Sale, ibid., p. 116). Comparable research from 1995 for Finland delivered a result of 95%.
Scheerder, R.L. J.M. and Schrijvers, A. J. P.: Health Care Policy Making against an OECD Background, in: Schrijvers, A. J. P., (ed.): Health and Health Care in the Netherlands: A Critical Self-Assessment by Dutch Experts in the Medical and Health Sciences, De Tijdstroom, Utrecht, 1997, p. 248.
Donaldson, C. and Gerard, K.: Economics of Health Care Financing: The Visible Hand; Economic Issues in Health Care, MacMillan, 1993, chapter 2.
Ludmerer, K. M.: Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care, Oxford University Press, 1999, p. 122.
Ludmerer, K. M.: ibid., p. 119.
Ludmerer, K. M.: ibid.
Glied, S.: Chronic Condition: Why Health Reform Fails, Harvard University Press, 1997, p. 25.
Glied, S.: ibid., p. 140.
Moreover, it is uncertain whether this large number refers to people who cannot afford the insurance premium. In this respect, American research from 1987 found that only 37% of uninsured people had investigated the possibility of health insurance, and only 2.5% were ever denied coverage or offered limited coverage because of health conditions (Glied, S.: ibid., p. 140).
As for regulating the health care market in the United States, Maynard and Dixon refer to the so-called Jackson Hole group of academics who tried to set up a regulatory framework for a competitive health care market. The group identified six causes of market failure in the United States: (1) cost-unconscious demand, with providers and insurers not having an incentive to economize; (2) biased risk selection as a source of profit, which leads to providers’ garnering profits by product differentiation and cream-skimming; (3) market segmentation to minimize price competition, resulting in large numbers of benefit packages, thus making comparison and choice-making very difficult; (4) lack of information on outcomes relative to cost, causing little outcome measurement; (5) little choice for members of small groups, consequently offering people belonging to these groups hardly any opportunities to choose from different health care plans; and (6) perverse public subsidies, with tax breaks benefitting rich employees. Countering these market failures would demand extensive government regulation, including (1) universal access, which would ensure that every citizen has access to at least a minimum benefit package; (2) choice of packages, particularly directed at members of small groups; and (3) national regulation by standard-setting boards that would have to ensure uniform definitions and standards of performance. The Jackson Hole proposals were not accepted, however (Maynard, A. and Dixon, A.: Private Health Insurance and Medical Savings Accounts: Theory and Experience, in: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J., (eds.): Funding Health Care: Options for Europe, European Observatory on Health Care Systems Series, Open University Press, 2002, pp. 112–114).
Based on: Donaldson, C. and Gerard, K.: ibid., chapter 3.
It is worth mentioning that research has shown that more privately oriented health care systems appear to have higher costs of administration (Donaldson, C. and Gerard, K.: ibid., p. 30).
For more examples, see: Donaldson, C. and Gerard, K.: ibid., p. 34 and 89.
For more examples, see: Donaldson, C. and Gerard, K.: ibid., p. 34.
The Guardian, 17 May 1996.
Hayman, H.: The Nation’s Health, in: Radice, G., (ed.): What Needs to Change? New Visions for Britain, HarperCollins Publishers, 1996, p. 164.
Hayman, H.: ibid., p. 165.
White, S. and Stancombe, J.: Clinical Judgement in the Health and Welfare Professions: Extend the Evidence Base, Open University Press, 2003, p. 26.
Saltman, R. B.: A Conceptual Overview of Recent Health Care Reforms, in: European Journal of Public Health, volume 4, 1994, no. 4, p. 290.
Kuttner, R.: Everything for Sale, ibid., p. 19.
Saltman, R. B. and Figueras, J., (eds.): ibid., p. 40.
Kuttner, R.: Everything for Sale, ibid., p. 19.
Sandier, S., Paris, V., and Polton, D.: Health Care Systems in Transition: France, 2004, European Observatory on Health Systems and Policies, Thomson, S. and Mossialos, E., (eds.), WHO Regional Office for Europe, Copenhagen, 2004, p. 40.
New, B. and Le Grand, J.: Rationing in the NHS: Principles and Pragmatism, King’s Fund, 1996, p. 43.
Walt, G.: ibid., p. 49.
See: Saltman, R. B.: Assessing Social Health Insurance Systems: Present and Future Policy Issues, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., pp. 145–149.
Schut, F. T.: Competition in the Dutch Health Care Sector, Erasmus University, Rotterdam, 1995, pp. 39–40.
Schut, F. T.: ibid., p. 86.
Referring to the situation in the Netherlands, Van Doorslaer shows moderate optimism. To him, more market-like operation is inevitable if the Dutch want to improve health services delivery. Such a development does not necessarily detract from solidarity. On the contrary; if principles of financing are based on individuals’ capacity to pay taxes through a solidarity-based collection of premiums, and health services are delivered according to need via standardized distribution payments among insurers, income-and risk-solidarity might even increase (Doorslaer, E. K. A.: Gezondheidzorg tussen Marx en Markt, inaugural lecture, Erasmus University, Rotterdam, 1998, pp. 23–24). I do not share Van Doorslaer’s optimism. It is precisely the idea of income-related premiums that, over the past 18 years, has not attained political agreement. This also applies to the system reforms of 2006 for which policy tricks were necessary to get them accepted.
Brommels, M.: Contracting and Political Boards in Planned Markets, in: Saltman, R. B. and Otter, C. von, (eds.): Implementing Planned Markets in Health Care: Balancing Social and Economic Responsibility, Open University Press, 1995, p. 106.
Deppe, H-U.: Zur sozialen Anatomie des Gesundheitssystems: Neoliberalismus und Gesundheitspolitik in Deutschland, Verlag für Akademische Schriften, Frankfurt, 2000, p. 20.
Thus said Alan Maynard at the Ecosanté Conference in respect of the British government (Paris, November 1995).
According to Nigel Lawson in an interview, in: Deakin, N.: ibid., p. 144.
Illich, I.: Medical Nemesis (Dutch Translation), Het Wereldvenster, Baarn, 1975, p. 93.
Raad voor de Volksgezondheid en Zorg:Technologische Innovatie in de Zorgsector, Zoetermeer, 2001, p. 50.
Gevaerts, P.O. H.: De Patientenorganisaties, in: Lens, P. and Kahn, Ph. S., (eds.): Over de Schreef: Over Functioneren en Disfunctioneren van Artsen, uitgeverij Van der Wees, Utrecht, 2001, p. 377.
Trappenburg, M.: Gezondheidszorg en Democratie, inaugural lecture, Erasmus University, Rotterdam, 2005, p. 9.
Verkaar, E. A. M. J.: Strategisch Gedrag van Kategorale Patientenorganisaties, dissertation, Rotterdam, 1991.
Attempts in the Netherlands to reach consensus on a change of policy after the Dekker report failed for this reason (Björkman, J. M. and Okma, K. G. H.: Restructuring Health Care Systems in the Netherlands: Institutional Heritage of Dutch Health Policy Reforms, in: Altenstetter, Ch. and Björkman, J. W., (eds.): ibid., pp. 101–103).
Raffel, M.W.: Dominant Issues: Convergence, Decentralization, Competition, Health Services, in: Raffel, M.W., (ed.): ibid., p. 302.
Dent, M.: ibid., p. 101.
Durieux, P., et al.: The “Natural History” of the Introduction and Development of the First Lithotripter in France, Paper for the EEC workshop on regulatory mechanisms concerning medical technology, London, 22–25 April, 1986.
Stocking, B., (ed.): Expensive Health Technologies: Regulatory and Administrative Mechanisms in Europe, Oxford University Press, 1988, p. 175.
Gooijer, W. J. de: Over Zorggestuurde Vraag en Vraaggestuurde Zorg, in: Dijkstra, G. S. A., Meer, F. M. van der and Rutgers, M. R., (eds.): Het Belang van de Publieke Zaak, Eburon, 2003, pp. 137–138.
Wildner, M., Exter, A. P. den, and Kraan, W. G. M. van der: The Changing Role of the Individual in Social Health Insurance Systems, in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 252.
In this respect, the American philosopher Daniels, for example, delineates the characteristics which a health care system needs to possess in order for it to be called a just system. In such a system, the responsibility of the state is limited to providing individual citizens a fair equality of opportunity to species-typical normal functioning. Negative deviations from the norm cause health care needs, which have to be distinguished from health care preferences. Where treatment can restore health, the health care need at issue constitutes a legitimate claim for care as a moral right. Services regarding health care preferences, as well as those which do not result in restoration of equal opportunity (care for the mentally retarded, for example), do not belong in the health care domain. In short: according to Daniels, health care needs “are concerned with maintaining, restoring, or compensating normal species functioning” (in: Vathorst, S. van de: ibid., pp. 34 and 37).
Meij, A. W. H. en Zimmeren, E. van, ibid.
See www.usembassy.nl. (2003)
Cliteur, P.: ibid., p. 101.
Wildner, M., Exter, A. P. den, and Kraan, W. G. M. van der: ibid., p. 257.
Commissie van de Europese Gemeenschappen: Communautaire Samenwerking op het Gebied van de Volksgezondheid: Mededeling van de Commissie aan de Raad, COM(84) 502 def., Brussels, 18 September 1984.
In this respect, recent research in the Netherlands showed that almost half of all respondents were prepared to pay a higher health insurance premium in order to maintain the principle of solidarity (Bongers, I. M. B., Weert, C. M. C. van, Vis, C. M., Garretsen, H. F. L. and Das, M.: Kwaliteit en Kwantiteit van de Gezondheidszorg en Actuele Beleidsontwikkelingen in de Gezondheidszorg in 2005: Nederlanders aan het Woord, Universiteit van Tilburg, 2005, p. 44).
Asperen, G. M. van: Jouw Geld of mijn Leven, in: Jacobs, F. C. L. M. en Wal, G.A. van der, (eds.): Medische Schaarste en het Menselijk Tekort, Baarn, 1988, p. 54.
Decker, N.: Cross-Border Cooperation and Free Movement of Patients: The Different Viewpoints, in: Free Movement and Cross-Border Cooperation in Europe: The Role of Hospitals & Practical Experiences in Hospitals, Proceedings of the HOPE Conference and Workshop, Luxembourg, June 2003, p. 62.
Here, formulations may differ between countries. For the Netherlands, for example, the constitutional formulation regarding health is an item of the basic law that provides the foundation of universal social rights and entitlements, which are legally formulated in the Sick Fund Law and the Law on Exceptional Medical Expenses. Conversely, Italy has formulated the right to health and health care almost as an individual item of basic rights (Hermans, H. E. G. M. and France, G.: Beperkingen aan het Recht op Gezondheidszorg: Realisering Zorgaanspraken in Nederland en Italië, in: Sociaal Recht, 1998–2, pp. 47–54).
Commission of the European Communities: Communication from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions on the Health Strategy of the European Community: Proposal for a Decision of the European Parliament and of the Council, adopting a programme of Community Action in the Field of Public Health (2001–2006), COM (2000) 285 final, Brussels, 16.5.2000, p. 8.
Friedman, E.: Because Someone Has To Be Responsible: Duty and Dilemma for the American Hospital, in: Friedman, E., (ed.): Making Choices: Ethical Issues for Health Care Professionals, American Hospital Association, 1986, pp. 79–84.
Commissie van de Europese Gemeenschappen: Mededeling van de Commissie aan de Raad, het Europees Parlement, het Economisch en Sociaal Comité en het Comité van de Regio’s. De Toekomst van de Gezondheidszorg en de Ouderenzorg: de Toegankelijkheid, de Kwaliteit en de Betaalbaarheid waarborgen, ibid., p. 4.
Kam, F. de en Nypels, F.: Tijdbom, Amsterdam/Antwerpen, 1995, p. 22.
Kam, F. de en Nypels, F.: ibid., pp. 16–17.
By the late 1980s, around 28 million Americans were AARP members. The organization employed 1,300 staff members—(Pierson, P.: The New Politics of the Welfare State, in: Pierson, Chr. and Castles, F., (eds.): ibid., p. 311).
Becker, H.: De Toekomst van de verloren Generatie, Amsterdam, 1997, p. 74.
Komter, A. E., et al.: Het Cement van de Samenleving: Een Verkennende Studie naar Solidariteit en Cohesie, Amsterdam University Press, 2000, chapter 5.
Komter, A. E., et al.: ibid., p. 80.
Wittenberg, R., Sandhu, B., and Knapp, M.: Funding Long-Term Care: The Public and Private Options, in: Mossialos, E., Dixon, A., Figueras, J., Kutzin, J., (eds.): ibid., pp. 246–247.
Kam, F. de and Nypels, F.: ibid., p. 21.
Rifkin, J.: The European Dream, ibid., p. 254.
Dykstra opposes the idea that the growing number of elderly people is responsible for the increasing costs of health care. To him, the determining factors are increasing labor costs and the use of new technologies. However, Dykstra misses several points here. First of all, in contrast to some 25 years ago, almost 60% of nursing days in general hospitals are consumed by people over 65 years old. Secondly, new technologies and developments in the pharmaceutical industry contribute enormously to the aging of the population (in: Komter, A. E., et al.: ibid., p. 80).
Kam, F. de and Nypels, F.: ibid.
Fairlamb, D.: ibid.
Ours, J. van: Schaarste op de Arbeidsmarkt: nou én? in: Dalen, H. van and Kalshoven, F., (eds.), ibid., p. 111.
Judt, T.: ibid., p. 105.
Bovenberg, L: Nieuwe Spelregels voor een Nieuwe Levensloop, in: Dalen, H. van and Kalshoven, F., (eds.), ibid., pp. 71–72.
In this respect, in has been calculated for the United States that it took 4.8 working-age adults to fund health care for one person over 65 years of age in 1993. By 2030, when the last baby boomers will have retired, there will only be 2.8 working-age adults to pay for the health care costs of each person over 65, which may be partly compensated by the fact that post-baby boomers will have fewer children under 19 to support (Glied, S.: ibid., p. 136).
Kam, F. de and Nypels, F.: ibid., p. 129.
McKee, M., Healy, J., Edwards, N., and Harrison, A.: Pressures for Change, in: McKee, M. and Healy, J., (eds.): Hospitals in a Changing Europe, European Observatory on Health Care Systems Series, Open University Press, 2002, p. 39
Mossialos, E. and Le Grand, J.: Cost Containment in the EU: An Overview, in: Mossialos, E. and Le Grand, J., (eds.): ibid., pp. 55–56.
Bleichrodt, H. Het Dilemma van de Minister van Volksgezondheid, in: Dalen, H. van and Kalshoven, F., (eds.), ibid., pp. 201–211.
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Jochemsen, H.: ibid., p. 20.
Ansieau, G.: Belgium: One Year after the Decriminalisation of Euthanasia, in: Hospital: Official Journal of the European Association of Hospital Managers, Volume 5, Issue 6/2003, p. 23.
Ansieau, G.: ibid., p. 23.
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Gross, N.: ibid., p. 22.
Commission of the European Communities: Report from the Commission to the Council, the European Parliament and the Economic and Social Committee on the Integration of Health Protection Requirements in Community Policies, ibid., p. 33.
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Herten, L. van and Gunning-Schepers, L. J.: Historical Perspectives on European Health and Policy, in: Marinker, M., (ed.): ibid., p. 28.
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Health Council of the Netherlands: The Future of Our Selves, ibid., p. 81.
Health Council of the Netherlands: The Future of Our Selves, ibid., p. 85.
Coulter, A. and Magee, H., (eds.): The European Patient of the Future, Open University Press, 2004, p. 124.
Dijn, H. de: Technology in Health Care: A Philosophical Ethical Appraisal, in: Gastmans, Chr., (ed.): ibid., p. 20.
Dijn, H. de: ibid., p. 16.
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(2007). Health Care and the Economic Order. In: Trends in EU Health Care Systems. Springer, New York, NY. https://doi.org/10.1007/978-0-387-32748-8_5
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