Regulatory Strategies Under Managed Competition Health Care Reforms

1995 ◽  
pp. 45-79 ◽  
Author(s):  
Mark Schlesinger
Keyword(s):  
Health Care ◽  
Managed Competition ◽  
Health Care Reforms ◽  
Regulatory Strategies

Caught in the “Traps of Managed Competition”? Examples of Russian Health Care Reforms from St. Petersburg and the Leningrad Region

1997 ◽  
Vol 27 (4) ◽  
pp. 661-686 ◽  
Author(s):  
Sarah Curtis ◽  
Natasha Petukhova ◽  
Galina Sezonova ◽  
Nadia Netsenko
Keyword(s):  
Health Care ◽  
Health Service ◽  
Service Systems ◽  
Leningrad Region ◽  
Managed Competition ◽  
Health Care Reforms ◽  
Future Policy ◽  
The City ◽  
Different Parts

Elements of a “managed market” for health services have been introduced into the Russian health care system, which under the Soviet regime was run as a comprehensive state-managed system. The authors examine the recent development of health service reforms in a case study of the city of St. Petersburg and the surrounding Leningrad region. Evidence from key informants and a local survey of service users shows how alternative models of the managed market are being introduced in different parts of the study area. A critical review of the market-oriented strategies for reform emerging in the case study suggests that such reforms carry risks associated with the “traps of managed competition.” Future policy for health service systems in Russia must take these risks more fully into account.

scholarly journals The impact of hospital competition and insurer concentration on health care volume and cost in Dutch hospitals

2019 ◽  
Vol 93 (7/8) ◽  
pp. 203-213
Author(s):  
Yvonne Krabbe-Alkemade ◽  
Tom Groot ◽  
Jaap Boter
Keyword(s):  
Health Care ◽  
Hospital Competition ◽  
Production Volume ◽  
Managed Competition ◽  
Spatial Concentration ◽  
Hospital Data ◽  
Health Care Reforms ◽  
Hospital Markets ◽  
The Impact ◽  
Health Care Production

This study analyses the effect of spatial concentration of general hospitals, the appearance of independent treatment centers (in Dutch: Zelfstandige Behandelcentra: ZBCs) and the concentration of health insurers on production volume and costs since the introduction of market-oriented health care reforms in the Netherlands. We use regression analyses of 1,345,144 patient-level hospital data for fifteen major diagnosis treatment combinations (in Dutch: Diagnose Behandeling Combinaties: DBCs), representing 70% of the managed competition segment (the so-called B-segment). We find that spatial concentration of hospitals and concentration of insurers do not affect health care production volume. More competitive hospital markets are associated with higher cost of most DBCs studied. Surprisingly, hospitals operating under insurers with high monopsonic power incur higher average DBC-cost than hospitals operating under insurers with more dispersed power. The number of independent treatment centers in the hospital’s vicinity is positively related to health care volume and average cost.

COST CONTAINMENT AND ACCESS TO CARE: THE SHANGHAI HEALTH CARE FINANCING MODEL

2008 ◽  
Vol 53 (01) ◽  
pp. 27-41 ◽  
Author(s):  
WEIZHEN DONG
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Cost Containment ◽  
Access To Health Care ◽  
Health Care Cost ◽  
Health Care Expenditure ◽  
Health Care Financing ◽  
Insurance Scheme ◽  
Health Care Reforms ◽  
Medical Savings Account

The medical savings account (MSA) model of health care financing is viewed as a health care cost containment strategy. Yet, health care expenditure in Shanghai has increased sharply since the adoption of the MSA system. This paper looks into the health care reforms in Shanghai, especially since the introduction of the MSA scheme. From the Labor Insurance Scheme and Government Insurance Scheme to the Medical Savings Account scheme, ordinary Shanghai residents have not benefited from the most recent health care reforms. They have found medical care much less affordable. Disparity in access to health care access has become more evident than ever. Meanwhile, health care cost has increased sharply. China has benefited from an emphasis on prevention and primary care, but the government's recent policies give a high priority to catastrophic disease. This is not a cost-effective approach. Shanghai's health care system needs to break socioeconomic class boundaries if it is to construct a harmonious society. Shanghai's decision makers and various stakeholders have the resources and wisdom to face the challenge.

Substantive Equality in South African Health Care: The Limits of Law

2000 ◽  
Vol 4 (2) ◽  
pp. 111-131 ◽  
Author(s):  
Charles Ngwena
Keyword(s):  
Health Care ◽  
South African ◽  
Access To Health Care ◽  
Health Care Services ◽  
Health Care Reforms ◽  
Structural Inequality ◽  
Care Services ◽  
Substantive Equality ◽  
African Health ◽  
Access To Health

The article considers the scope and limits of law as an instrument for facilitating equitable access to health care in South Africa. The focus is on exploring the extent to which the notion of substantive equality in access to health care services that is implicitly guaranteed by the Constitution and supported by current health care reforms, is realisable for patients seeking treatment. The article highlights the gap between the idea of substantive equality in the Constitution and the resources at the disposal of the health care sector and the country as a whole. It is submitted that though formal equality in access to health care services has been realised, substantive equality is currently unattainable, if it is attainable at all, on account of entrenched structural inequality, general poverty and a high burden of disease.

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