Introduction to the Book

Abstract

Healthcare systems in OECD countries seem to be in a state of permanent transformation.¹ The economic recession following the oil price shocks of the 1970s triggered a broad range of cost containment measures in welfare state policies that would continue through four decades up to the present, where OECD healthcare systems face a new phase of economic turmoil brought on by our most recent financial crisis (see Starke 2006; 2007). This is not to suggest, however, that national governments have had an easy time curtailing public financing as well as provision in the field of welfare policy (Pierson 1994). This holds true particularly for the healthcare sector, as its legitimacy is in most countries largely based on its ability to provide a satisfactory standard of healthcare for all citizens, irrespective of their ability to pay for care. As demographic change and advancements in medical technology increase the demand for healthcare, globalization limits the amount of public funds that can go into it. As a result, the need for reforms that assure cost containment and at the same time guarantee high quality healthcare services for the population has increased. Interestingly, evidence suggests that although common challenges are experienced, the responses to various socio-economic pressures have differed considerably across healthcare system types (OECD 1994; Tuohy 1999). Starting in the 1990s, for example, we observe that in many predominantly publicly financed healthcare systems, market-oriented healthcare reforms have been implemented or proposed (Freeman and Schmid 2008; van de Ven 1996), whereas in the US, where private insurance plays a dominant role, access to healthcare and the introduction of universal health insurance have gained political salience, particularly during the presidency of Obama (Skocpol 1994; The White House 2009).