Slovakia

2021 ◽  
pp. 767-787
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
Social Health Insurance ◽  
Political Conflict ◽  
Social Health ◽  
Managed Competition ◽  
Healthcare Provision ◽  
Health Politics ◽  
Dramatic Shift ◽  
Insurance Model

This chapter offers an in-depth look at health politics and the health system in Slovakia based on compulsory social health insurance. It traces the development of the Slovak healthcare system, characterized by the shift from a social health insurance model to a Semashko model of health provision under communism. Slovak post-communist health politics has been marked by strong left–right political conflict and institutional barriers to reforms. Nevertheless, health policy in Slovakia displays a dramatic shift to a market-oriented healthcare provision based on user fees and managed competition, introduced in 2003 and 2004. Attempts to reverse market-oriented reforms were partially successful and have involved supranational and international authorities of the European Commission and of the International Court of Arbitration. As outlined in the chapter, some of the main issues facing the Slovak healthcare system have been overcapacity in the hospital sector, a malfunctioning referral system, and corruption.

Serbia

2021 ◽  
pp. 918-928
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Waiting Lists ◽  
The Self ◽  
Social Health ◽  
Healthcare Provision ◽  
Health Politics ◽  
Insurance System ◽  
Insurance Model ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Serbia based on compulsory social health insurance. It traces the development of the Serbian healthcare system after the breakup of Socialist Federal Republic of Yugoslavia, characterized by a move from the self-managed insurance model to a more standard Bismarckian health insurance system combined with passive privatization. Despite efforts to restructure healthcare provision through a reform in 2005, the system’s two-tier structure remains firmly entrenched, protected by professional interests. The chapter highlights other healthcare issues including long waiting lists and corruption.

Montenegro

2021 ◽  
pp. 929-938
Author(s):  
Natalija Perišić
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Healthcare Delivery ◽  
Social Health Insurance ◽  
Social Health ◽  
Healthcare Provision ◽  
Health Politics ◽  
Private Healthcare ◽  
Incomplete Coverage

This chapter examines health politics and the health system in Montenegro based on compulsory social health insurance. It traces the post-communist development of the Montenegrin healthcare system that started with incremental privatization and continued toward a more decisive move toward liberalization through the 2004 reforms, which included, among other elements, a stronger role of private healthcare delivery and the introduction of different types of voluntary insurance. As the chapter notes, the main issues facing the health system in Montenegro are incomplete coverage, limited access to healthcare, and lack of regulation of private healthcare provision.

Bulgaria

2021 ◽  
pp. 816-856
Author(s):  
Guergana Stolarov-Demuth
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
Free Market ◽  
Social Health Insurance ◽  
Social Health ◽  
Reform Process ◽  
Control Mechanisms ◽  
Public And Private ◽  
Health Politics ◽  
Insurance System

This chapter provides an extended look at health politics and the compulsory health insurance system in Bulgaria. It traces the historical development of the Bulgarian healthcare system characterized by the introduction of social health insurance, which after the establishment of communist rule in Bulgaria after World War II was replaced with a state-run healthcare system. Starting in 1989, Bulgaria underwent a transition to democracy and free market economy. This triggered structural healthcare reforms, including the re-introduction of social health insurance with both public and private provision. However, as privatization was permitted without effective price control mechanisms and conditions for entry into the public insurance system, out-of-pocket payments became extensive, especially for pharmaceuticals. The main reform challenges have been to close the coverage gaps and secure sufficient financing by stipulating selective contracting with hospitals, strengthening the control on pharmaceuticals, and tightening the collection of insurance contributions. While political debates were initially structured along traditional left–right political party lines, since 2001 new center-right parties have shaped Bulgarian health politics. Nevertheless, the reform process still suffered from lack of continuity, and private interest groups have successfully blocked cost-containment policies.

Hungary

2021 ◽  
pp. 723-744 ◽  
Author(s):  
Mária Éva Földes
Keyword(s):  
Health Insurance ◽  
Universal Access ◽  
Social Health Insurance ◽  
Quality Of Healthcare ◽  
Social Health ◽  
Managed Competition ◽  
Access To Health Services ◽  
Access To Health ◽  
The Social ◽  
Insurance Model

This chapter offers an in-depth look at health politics and the social health insurance-based system in Hungary. It traces the development of the Hungarian healthcare system, characterized by seismic shifts from a Bismarckian, solidarity-based social health insurance to centrally planned healthcare pledging universal access to health services as a citizen’s right. After the fall of state socialism, Hungary returned to a social health insurance model, and since then the main policy efforts have focused on decentralization, strengthening of private provision and entrepreneurship, and financial consolidation of the health system. After the highly contested and ultimately failed attempt to introduce managed competition and user fees between 2006 and 2008, there has been a shift back to an increasingly centralized system with tax-based financing. As noted in the chapter, the consequences of recentralization for the solidarity, accessibility, affordability, and quality of healthcare in Hungary are still to be seen.

Supplementary Health Insurance and Regulation of Healthcare Systems

2019 ◽  
Author(s):  
Brigitte Dormont
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Social Insurance ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Social Health ◽  
Managed Competition ◽  
Benefit Package ◽  
Care Services ◽  
Supplementary Health Insurance

Most developed nations provide generous coverage of care services, using either a tax financed healthcare system or social health insurance. Such systems pursue efficiency and equity in care provision. Efficiency means that expenditures are minimized for a given level of care services. Equity means that individuals with equal needs have equal access to the benefit package. In order to limit expenditures, social health insurance systems explicitly limit their benefit package. Moreover, most such systems have introduced cost sharing so that beneficiaries bear some cost when using care services. These limits on coverage create room for private insurance that complements or supplements social health insurance. Everywhere, social health insurance coexists along with voluntarily purchased supplementary private insurance. While the latter generally covers a small portion of health expenditures, it can interfere with the functioning of social health insurance. Supplementary health insurance can be detrimental to efficiency through several mechanisms. It limits competition in managed competition settings. It favors excessive care consumption through coverage of cost sharing and of services that are complementary to those included in social insurance benefits. It can also hinder achievement of the equity goals inherent to social insurance. Supplementary insurance creates inequality in access to services included in the social benefits package. Individuals with high incomes are more likely to buy supplementary insurance, and the additional care consumption resulting from better coverage creates additional costs that are borne by social health insurance. In addition, there are other anti-redistributive mechanisms from high to low risks. Social health insurance should be designed, not as an isolated institution, but with an awareness of the existence—and the possible expansion—of supplementary health insurance.

The Czech Republic

2021 ◽  
pp. 683-722
Author(s):  
Tamara Popic
Keyword(s):  
Czech Republic ◽  
Healthcare System ◽  
Social Health Insurance ◽  
Controversial Issues ◽  
Healthcare Provision ◽  
The Czech Republic ◽  
Health Politics ◽  
Insurance System ◽  
Political Divide ◽  
Universal Health

This chapter provides an extended look at health politics and the universal health system based on a compulsory social health insurance in the Czech Republic. It traces the historical development of the Czech healthcare system, characterized by a systemic shift from an insurance system to a fully state-run Soviet Semashko model of healthcare provision. Since the fall of communism in 1989, the Czech healthcare system has undergone significant reforms, including a return to a Bismarckian insurance system and market-oriented reforms in delivery and financing of health services. The post-communist reforms were characterized by the crystallization of the left–right political divide in healthcare policymaking. As the chapter argues, this division became particularly pronounced in the context of reforms introducing user fees for medical services and hospital privatization, both of which were controversial issues, with critics arguing that these reforms posed a major threat to the system’s solidarity.

The Netherlands

2021 ◽  
pp. 520-557
Author(s):  
Karen M. Anderson ◽  
Ruud J. Van Druenen
Keyword(s):  
Health Insurance ◽  
The Netherlands ◽  
Party System ◽  
Large Scale ◽  
Private Insurance ◽  
Social Health Insurance ◽  
State Regulation ◽  
Managed Competition ◽  
Health Politics ◽  
Private Actors

This chapter provides an extended look at health politics and the mandated health insurance system in the Netherlands. It traces the historical development of the Dutch healthcare system, analyzing the emergence of a bifurcated public–private system and its replacement with mandated private insurance in 2006. The Dutch case is thus notable for large-scale privatization accompanied by expanding state regulation of private actors. Dramatic shifts in the party system since the 1980s shaped reform processes as the center-left consensus in favor of social health insurance and redistributive financing was replaced by center-right consensus supporting managed competition among private insurers. Reforms adopted since 2005 have aimed to control costs without sacrificing quality, largely by strengthening managed competition and the regulation underpinning it.

Slovenia

2021 ◽  
pp. 788-808
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Primary Care Physicians ◽  
Private Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Party Competition ◽  
Social Health ◽  
Large Hospital ◽  
Health Politics ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Slovenia based on compulsory social health insurance. It traces the development of the Slovenian healthcare system from the first health insurance schemes to the more established insurance system with universal coverage and focus on social medicine under communism. Since its independence in 1992, Slovenian politics has been marked by a pragmatic model of party competition with an important role in healthcare policymaking played by neo-corporatist structures. The major post-communist reform was the introduction of complementary private health insurance in 1993, which covers the majority of the population. Several unsuccessful reform proposals sought the abolition of complementary private insurance, the fairness of which remains the most controversial question regarding the system. Other healthcare issues outlined in the chapter include large hospital debt and uneven distribution of primary care physicians.

Poland

2021 ◽  
pp. 745-766
Author(s):  
Tamara Popic
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Public Hospitals ◽  
Social Health ◽  
Health Politics ◽  
Insurance System ◽  
Out Of Pocket Payments ◽  
Healthcare Politics ◽  
Veto Points ◽  
Universal Health

This chapter offers an in-depth look at health politics and the universal health system in Poland, financed through social health insurance. It traces the development of the Polish healthcare system under communism, characterized by a complete shift from an insurance system to a state-run Soviet Semashko model of healthcare with some elements of private provision. Since 1989, Polish health policy went through systemic changes which included a shift to a decentralized social health insurance system in the late 1990s and re-centralization in 2001. Polish healthcare politics has been turbulent, marked by political instability matched by a dense network of veto points, including the President and the judiciary, that had an impact on the direction of health reforms. As the chapter highlights, some of the main issues have been high out-of-pocket payments, corruption, and privatization and commercialization of public hospitals.

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