The Economics of Public Health Care Reform in Advanced and Emerging Economies
Back Matter

Back Matter

Author(s):
David Coady, Benedict Clements, and Sanjeev Gupta
Published Date:
June 2012
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    Contributors

    Tsung-Mei Cheng, Health Policy Research Analyst, Princeton University

    Mita Choudhury, Associate Professor, National Institute of Public Finance and Policy, India

    Benedict Clements, Division Chief, Fiscal Affairs Department, International Monetary Fund

    David Coady, Deputy Division Chief, Fiscal Affairs Department, International Monetary Fund

    Sanjeev Gupta, Deputy Director, Fiscal Affairs Department, International Monetary Fund

    Masako Ii, Professor of Economics, Hitotsubashi University

    Eva Jenkner, Senior Economist, Fiscal Affairs Department, International Monetary Fund

    Pongpisut Jongudomsuk, Director, Health Systems Research Institute, Thailand

    Ludwig Kanzler, Principal, McKinsey & Company, Japan

    Izabela Karpowicz, Economist, Office of Budget and Planning, International Monetary Fund

    Kenichiro Kashiwase, Economist, Fiscal Affairs Department, International Monetary Fund

    Soonman Kwon, Professor of Health Policy and Management, Seoul National University

    John C. Langenbrunner, Lead Economist, World Bank

    Supon Limwattananon, Associate Professor, Khon Kaen University, Thailand

    Adun Mohara, Researcher, Health Intervention and Technology Assessment Program, Thailand

    Alexander Ng, Associate Principal, McKinsey & Company, Hong Kong

    Kumaree Pachanee, Research Assistant, International Health Policy Program, Thailand

    Walaiporn Patcharanarumol, Researcher, International Health Policy Program, Thailand

    Phusit Prakongsai, Director, International Health Policy Program, Thailand

    M. Govinda Rao, Director, National Institute of Public Finance and Policy, India

    Uwe E. Reinhardt, James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University

    Baoping Shang, Technical Assistance Advisor, Fiscal Affairs Department, International Monetary Fund

    Jonathan Skinner, Professor of Economics, Dartmouth College

    Mauricio Soto, Economist, Fiscal Affairs Department, International Monetary Fund

    Samrit Srithamrongsawat, Director, Health Insurance System Research Office, Thailand

    Michael Stolpe, Economist, Kiel Institute for the World Economy

    Catherine Suarez, Investment Management Analyst, Goldman Sachs

    Ajay Tandon, Senior Economist, World Bank

    Viroj Tangcharoensathien, Senior Expert, Ministry of Public Health, Thailand

    Justin Tyson, Senior Economist, European Department, International Monetary Fund

    Index

    [Page numbers followed by f, n, or t refer to figures, footnotes or tables, respectively.]

    A

    Access to care

    • basic functions of health care system, 70

    • benefits of, 283

    • China’s efforts to improve, 337

    • copayment and, 172

    • in developing countries of Asia, 57

    • in East Asia and Pacific countries, 139-40

    • effects of budget caps, 105

    • egalitarian approach, 72

    • in India, 284, 293, 294t

    • in Japan, 210, 212

    • in low- and middle-income countries, 283-84

    • in Mexico, 344

    • in multitiered system, 73

    • outcomes of Sweden’s cost containment reforms, 197

    • private sector role in health system and, 11, 62-63

    • regulatory requirements for private insurance, 64

    • role of government in providing, 283

    • in rural Thailand, 322

    • in Taiwan Province of China, 263

    • in two-tiered health system, 72-73

    Administrative costs

    • information technology to reduce, 17, 272

    • insurance premium setting, 82

    • medical technology and, 265

    • in private insurance system, 62

    • in Taiwan Province of China, 258, 265, 272

    • in United States, 272

    Administrative reforms. See Public management reforms

    Advanced economies

    • of Asia, 56

    • case studies of cost containment efforts, 14-17, 101-02, 177

    • data sources, 30

    • demand-side reforms, effectiveness of, 110, 110f; 112

    • education spending, 27

    • excess cost growth projections, 45-47, 46t

    • health status, 29

    • life expectancy, 29

    • macro-level reforms, effectiveness of, 105-07, 111

    • micro-level reforms, effectiveness of, 107-09, 111-12

    • projected public health spending, 37-42, 38f 43

    • public health spending patterns, 7, 23-27, 26t, 29-30, 31;, 32t, 33f 101, 157

    • reform strategies, 121 t 177

    • utilization in, versus developing economies, 168

    • variation and convergence in public health spending among, 25-27, 30

    • See also specific country

    Affordable Care Act, 92

    Aging, population

    • cause of increases in public health spending, 24-25

    • in Chile, 341

    • in China, 337

    • excess cost growth projections, 49

    • health spending projections, 9, 10

    • in Japan, 15, 212, 214-15, 217, 218

    • projected health spending related to, 37, 43

    • in Republic of Korea, 222, 224-26

    • in Taiwan Province of China, 277

    • in Thailand, 323

    • trends in East Asia and Pacific, 153-54, 155

    Alcohol use, 5

    Allocative inefficiencies, 5-6, 75

    Angioplasty, 159

    Anti-retroviral drugs, 159

    Arthroscopic surgery, 158, 160

    Asia

    • causes of increased health spending, 59-60

    • developed countries, 56

    • developing countries, 57

    • economic status of southeast Asian nations, 309-10, 310t

    • efforts to reduce public health spending, 55-56

    • emerging economies, 56-57

    • fiscal capacity to expand public health spending, 126

    • health care reform goals, 12, 13

    • insurance system effects on household finances, 131

    • projected public health spending, 42

    • public health spending, 129

    • public insurance benefit packages in emerging economies of, 127-28, 129

    • variation in health care systems among countries of, 56-58, 67f

    • See also Asia, private insurance in; East Asia and Pacific; specific country

    Asia, private insurance in

    • access to care and, 62-63

    • copay policies and alternatives, 65

    • cost control benefits, 61-62

    • current system, 60-61

    • future prospects, 61, 66-67

    • policy questions, 56

    • possible models for, 60f, 67f

    • premium setting, 63

    • quality of care benefits, 63

    • regulatory system for, 63-64

    • role of, 10-11, 56, 58, 66

    Association of Southeast Asian Nations, 309-10, 310t

    Australia

    • efficiency of care, 29

    • future prospects, 114

    • health care spending, 56

    • influenza vaccination rate, 161-62

    • public health spending trends, 25

    Austria

    • future prospects, 114

    • influenza vaccination rate, 161-62

    B

    Baumol effect

    • definition, 5n, 37n

    • projected health spending related to, 37, 43

    • trends in advanced economies, 24

    Belgium, 114, 167

    Bismarck model, 86, 87

    Brazil, 27

    Budget caps

    • Canada’s reform experience, 180-81

    • definition, 103, 178

    • drawbacks, 105

    • Dutch reform experience, 192-93

    • effectiveness of, in advanced economies, 102, 106f, 112, 113, 182

    • Finland’s reform experience, 185

    • Germany’s reform experience, 233, 239

    • implementation, 105

    • Sweden’s reform experience, 196

    • United Kingdom’s reform experience, 200

    Bulgaria, 27

    C

    Cambodia

    • access to care, 57

    • contracting practices, 146-47

    • health care spending, 57, 139

    • health status, 137

    • health system inequalities, 140

    • income inequality, 135

    • insurance model, 144, 145, 152

    • provider payment system, 153

    Canada

    • budget cap experience, 14, 105

    • citizen satisfaction with health system, 92

    • cost containment policies, 112, 180-81

    • financing of health care system, 179

    • future prospects, 114

    • health spending, 179, 180f

    • infant mortality, 29

    • insurance system, 86, 87

    • key health indicators, 179t

    • lessons from reform experience of, 14, 182

    • outcomes of cost containment policies, 181-82

    • out-of-pocket spending, 89

    • per capita spending, 180, 180t

    • price control experience, 106

    • private purchase of health services, 72-73, 179, 182

    • public health spending trends, 25, 179, 180, 180f

    • social ethic commitments in health system, 72, 76-77

    • supply restriction policies, 14, 106

    Cancer, 276-77, 314

    Capitation

    • definition, 62

    • in Hungary, 127

    • Taiwan Province of China’s payment system, 17, 264-65, 276

    • in Vietnam, 149, 153

    • See also Managed care

    Case-based practice

    • disease management programs in Germany, 250-51

    • effectiveness in cost containment, 12, 107

    • recommendations for Republic of Korea, 230

    Case studies

    • advanced economies, 14-17, 101-2. See also specific country

    • analytical methodology, 102

    • emerging economies, 18-19. See also specific country

    Center for Alcohol Studies, 314

    Childhood vaccination, 168, 169f

    Chile

    • budget management, 128

    • cost containment challenges, 340-41

    • decentralization of health system, 340

    • economic indicators, 339, 339t

    • future challenges, 341

    • health care delivery system, 338

    • health care system inequities, 19, 341

    • health spending, 339, 340-41

    • insurance system, 128, 338, 341

    • lessons from reform experience of, 341

    • population health, 29, 338-39, 339t

    • public health financing, 129

    • reform experience, 19, 340

    China

    • current insurance market, 56, 58

    • disease burden trends, 337

    • economic indicators, 334, 335t

    • efforts to reduce public health

    • spending, 55

    • future challenges and opportunities, 19, 336-37

    • health care spending, 56-57, 148, 291, 334-35, 336

    • health system inequalities, 140

    • income inequality, 135

    • insurance model, 145, 146, 148-49, 334, 335-36

    • lessons from reform experience of, 337-38

    • out-of-pocket payments, 148, 335, 336

    • payment system, 336, 338

    • population aging, 337

    • population health, 334, 335t

    • preventive care, 336, 337

    • price control reforms, 336

    • private sector health care, 334

    • reform experience, 19, 335-36

    • rural-urban inequalities, 137-38, 335-36, 337

    • utilization patterns, 148, 337

    Cirrhosis, 266

    Citizen satisfaction with health system, 92

    Communicable diseases

    • drivers of health spending, 5

    • in India, 286-88

    Community-rated health insurance, 88-89

    Competition

    • among health care providers, 83, 272

    • among health insurers, 81-83, 272

    • on the basis of quality of care, 83

    • cost of care and, 82-83

    • current market functioning, 80

    • in Germany, 240-41, 242-43

    • in Mexico, 343

    • nature of, in health care, 81

    • for public health insurance contracts, 87-88

    • regulated, 95

    • in Republic of Korea, 221

    • in socialized health systems, 86

    • in Taiwan Province of China, 83, 272

    Consumer-directed health care, 89–90

    Contracting with private sector providers

    • in East Asia and Pacific, 146–47

    • effectiveness of, in cost containment in advanced economies, 107, 109

    • findings of cross-country studies, 13–14

    • Italy’s reform experience, 189

    • payment methods, 103, 178

    • to reduce public health spending, 103

    Copayment

    • access to care and, 172

    • alternatives, 65

    • based on cost-effectiveness of treatment, 171

    • effects on spending, 110

    • in Taiwan Province of China’s national health insurance, 260–62

    • utilization and, 65

    Cost-effectiveness of health care

    • categories of, 158–60

    • comparative analysis in German health system, 248–49

    • comparative analysis in Taiwan Province of China’s health system, 275

    • copayment charges based on, 171

    • data sources, 158

    • general practice medicine and, 167

    • in Germany, 235

    • international comparison, 165, 166t

    • measurement challenges, 157–58

    • measurement techniques, 158, 170–71

    • physician reimbursement based on, 171

    • production function approach to measurement of, 161–64

    • See also Efficiency

    Cost of care

    • competition in health system and, 82–83

    • cost-effectiveness evaluations, 107

    • disease profiles of emerging economies, 5

    • drivers of health spending, 5

    • for elderly, 277

    • functioning of current health care market, 78–81

    • in Germany, 235

    • growth rates, 271f

    • health spending trends, 9

    • information asymmetries in patient-physician relationship and, 79

    • international comparison, 271f

    • macro-level strategies to contain, 11–12

    • micro-level strategies to contain, 12

    • objectives of health care system, 3

    • pharmaceutical cost containment, 228–30

    • physician specialization and, 167

    • provider compensation and, 167–68

    • quality of care and, 14, 25, 83, 164

    • role of private insurers in controlling, 61–62

    • sources of increase, 59, 209

    • transparency of prices, 79–80

    • value concepts in health care, 75–76

    • See also Administrative costs; Cost-effectiveness of health care; Efficiency; Excess cost growth; Private health spending; Projected public health spending; Public health spending

    Cost-sharing schemes, 102

    • determinants of success, 103, 178

    • effectiveness, 12, 14, 110, 112

    • Estonia’s, 329

    • goals, 103, 178

    • health outcomes, 116

    • Hungary’s, 332

    • Italy’s, 14

    • Japan’s, 15

    • Taiwan Province of China’s, 17

    • in United States, 87

    Cost-utility analysis, 75–76

    Czech Republic

    • future prospects, 114

    • influenza vaccination rate, 161–62

    • public health spending trends, 25

    D

    Demand

    • causes of increase in public health spending, 24

    • in Japan, 210

    Demand-side reforms. See Cost-sharing schemes

    Denmark

    • citizen satisfaction with health system, 92

    • future prospects, 115

    • public health spending trends, 25

    Department of Veterans Affairs, 86

    Developing countries

    • of Asia, 57

    • health indicators, 289t

    • utilization in, versus developed countries, 168

    • See also specific country

    Diagnosis-related groups

    • copayment alternatives, 65

    • definition, 184 n

    • Finland’s implementation, 184, 185

    • Germany’s implementation, 17, 244-45

    • health outcomes, 116

    • insurance model, 62

    • purpose, 184n

    • Republic of Korea’s implementation, 16, 224

    • Thailand’s implementation, 311-12, 316

    Distributive social ethic

    • community-rated health insurance and, 88-89

    • consumer-directed health care and, 90

    • efficiency in health care and, 74-77

    • egalitarian approach, 72

    • free-market approach to health care and, 77-78

    • functioning of current health care market and, 83-84

    • goals of Japan’s health care system, 209

    • multitiered health system, 73-74

    • need for goal setting in health care reform, 11, 71-72, 73-74, 94

    • social health insurance model, 84

    • in two-tiered health system, 72-73

    • types of national health systems and, 85, 94-96

    • See also Equity

    E

    East Asia and Pacific

    • contracting practices, 146-47

    • economic performance, 134

    • fertility rate, 153

    • findings from cross-country studies, 13-14

    • future challenges and opportunities, 134, 153-55

    • health care financing in, 141-44, 142f, 153

    • health inequalities in, 13, 137-38, 139-40

    • health status, 135, 137, 153-54

    • income inequality, 134-35

    • insurance benefit package design, 146

    • pooling of insurance funds, 144-45

    • projected economic performance, 134f

    • provider payment systems, 147-48, 152-53

    • public health spending, 135-36, 138-39

    • public prepayment for health, 144

    • reforms to increase efficiency, 153

    • reform trends, 148-53

    • role of government in health system, 153

    • social health insurance in, 142-43

    • sociodemographic characteristics, 133, 153-55, 156

    • universal health coverage trends, 149

    • See also specific country

    Economic growth

    • in Chile, 339

    • in China, 334, 337

    • in East Asia and Pacific countries, 134, 134f

    • health care reform objectives of emerging economies and, 12

    • public health and, 3-4

    • public health spending and, 129, 131

    Education spending, 27

    Efficiency

    • challenges for Hungary, 332-33

    • challenges for Mexico, 344, 345

    • in China, 337, 338

    • concept of value, 75-76

    • conceptual model, 74f

    • data sources and analytical methodology, 31-35

    • definition, 74-75, 84

    • in East Asia and Pacific, 153

    • functioning of current health care market, 78-81

    • health outcomes and, 29

    • health outcomes of reforms to improve, 116-17, 157

    • information technology to improve, 111

    • international comparison, 4, 29

    • in Japan, 15, 216-17

    • Pareto model, 74f, 76

    • private sector versus government in health care delivery, 77

    • reform goals for emerging economies, 125, 129

    • in Republic of Korea, 221

    • role of insurers in delivering, 15

    • social ethics concerns and, 74-77

    • See also Cost-effectiveness of health care

    Emergency Medical Treatment and Active

    • Labor Act, 91

    Emerging economies

    • access to care, 283-84

    • of Asia, 56-57

    • case studies, 18-19

    • challenges for, 125-26, 129

    • data sources, 30-31

    • of Europe, 327

    • excess cost growth projections, 47-49, 48t

    • fiscal space needed for reforms, 125-26, 127f

    • health care reform needs, 12-13

    • health status, 29, 125

    • insurance benefit packages, 127-28, 129

    • labor market informality in, 129, 130

    • life expectancy, 29

    • objectives of reform, 125

    • projected public health spending, 42-43, 42f, 157

    • public health spending, 23, 30, 34f, 283

    • reform options, 126-29

    • trends in health spending, 23, 27, 28t, 30, 34f

    • See also specific country

    Epidemiologic trends

    • drivers of health spending, 5

    • in East Asia and Pacific, 153-54

    • public health spending in emerging economies and, 27

    • See also Aging, population; Noncommunicable diseases

    Equity

    • access to care in India, 284

    • aggregate health outcomes and, 4-5, 111

    • challenges for Mexico, 344

    • in Chile’s health system, 19, 341

    • consequences of administrative decentralization, 186

    • cost-sharing schemes and, 110

    • effects of private insurance on access to care, 62-63

    • in financing of health care in East Asia and Pacific, 144

    • health indicators in East Asia and Pacific countries, 13, 137-38, 139-40

    • income inequality in East Asia and Pacific, 134-35

    • in Japan’s insurance system, 212

    • objectives of health care system, 3, 70

    • private sector role in health system and, 11

    • regulatory goals for private insurance, 64

    • rural-urban inequalities, 137-38, 322, 335-36, 337

    • sources of inequality, 4

    • See also Distributive social ethic

    Estonia

    • cost-sharing plan, 329

    • economic indicators, 328t

    • future challenges, 329-30

    • health care provider supply, 329

    • health spending in, 327-28, 329-30

    • health system financing, 327, 328

    • hospital sector reform, 329, 330

    • insurance system, 328, 330

    • lessons from reform experience of, 330

    • micro-level reforms, 126

    • population health, 327, 328t, 330

    • primary care system, 328-29

    • public health spending trends, 27

    • reform experience, 19, 328-29

    • reimbursement system, 127

    Europe, advanced economies of integration of health care markets among, 251

    • projected health spending, 37-38, 40f

    • projected outcomes of health care reform, 40-42

    • See also specific country

    Europe, emerging economies of

    • excess cost growth projections, 47-48

    • health care reform goals, 12, 13

    • projected public health spending, 42

    • reform options, 126, 129

    • See also specific country

    Evidence-based reform, 310-16, 320-22, 323

    Excess cost growth

    • in advanced economies, 45-47, 46t

    • definition, 43

    • econometric modeling, 43-45

    • effectiveness of cost containment strategies in advanced economies, 102, 104t, 105, 110

    • effects of supplementary private insurance, 110

    • in emerging economies, 47-49, 48t

    • Finland’s reform experience, 185, 186f

    • Italy’s reform experience, 190, 190f

    • life expectancy effects, 49

    • outcomes of Canada’s cost containment policies, 181-82, 182f

    • private insurance and, 117

    • projected health spending related to, 10, 37, 42, 43-49

    • projected reform outcomes in advanced economies, 114, 115

    • as source of increase in public health spending, 9, 25

    • Sweden’s reform experience, 197, 198f

    • in United Kingdom, 201, 202f

    • in United States, 205, 205f

    Expectations, public, 3

    F

    Fee-for-service reimbursement, 61-62, 167-68, 273

    • in China, 336

    • copayment alternatives, 65

    • cost of care and, 276

    • in East Asia and Pacific, 147

    • in Japan, 211

    • policy trends in Asia, 55

    • supplier-induced demand, 79

    • in Thailand, 316

    Financing

    • basic functions of health care system, 69

    • in Canada, 179

    • in East Asia and Pacific, 141-44, 142f, 153

    • in Estonia, 327, 328

    • in Finland, 183

    • foreign aid, 170

    • in Germany, 237-38, 238f

    • health care reform challenges, 7-8

    • in Hungary, 331

    • in India, 18, 285, 297-99

    • India’s health system needs, 299-303, 304

    • international comparison, 211-12, 211t

    • in Italy, 186-87

    • in Japan, 209, 212, 213, 214-16

    • long-term care insurance in Republic of Korea, 16, 225-26

    • in Mexico, 343, 344

    • in Republic of Korea, 222

    • role of private sector in health system, 11

    • socialized medicine, 85-86

    • sources, 255-56

    • in Taiwan Province of China, 256, 258-62, 267-70, 268f, 274-75

    • in Thailand, 307, 308-09, 310

    • types of national health systems, 85, 85t

    • universal insurance coverage, 4, 17

    • See also Private insurance; Public health spending

    Finland

    • budget cap experience, 105

    • cost containment reforms, 184-85

    • cost-effectiveness of health spending, 165

    • decentralization of health system administration, 185, 186

    • demand-side reforms, 110

    • excess cost growth, 185, 186f

    • financing of health system, 183

    • future prospects, 115

    • key health indicators, 183t

    • lessons from reform experience of, 14, 186

    • life expectancy, 185

    • outcomes of cost containment reforms, 185

    • per capita spending, 185

    • pharmaceutical cost sharing, 185

    • public health spending trends, 25, 183-84, 185

    • structure of health system, 183

    • supply restriction policies, 106

    • tax policy, 185

    Foreign aid, 170

    France

    • future prospects, 114

    • out-of-pocket expenses, 238

    • projected outcomes of health care reform, 41

    • public health spending trends, 25

    G

    Gatekeeping, 103, 107, 147, 178, 179», 191, 198, 203

    General-practice physicians, 167

    German health care system

    • budget cap policies, 233

    • central health fund, 242-43

    • citizen satisfaction, 92

    • competition in, 240-41, 242-43

    • cost containment policies, 112, 233

    • demographic trends, 249-50

    • disease management programs, 250–51

    • employee contribution rates, 237, 238f

    • financing, 237–38, 238f 249–50

    • future prospects, 114, 249-51

    • global budget policies, 233, 238–39

    • implementation of diagnosis-related groups, 244–45

    • insurance system, 72, 73, 86, 87, 233–34, 240–42

    • lessons from reform experience of, 249

    • managed-care elements, 245

    • outcomes of cost containment efforts, 16–17, 233, 238–40

    • out-of-pocket spending, 89, 238, 239f

    • payment system, 245

    • pharmaceutical markets, 246–48

    • portability of aging provisions, 241-42

    • price control experience, 106–07

    • productivity concerns, 235

    • projected outcomes of reforms, 40, 41

    • prospective payment for hospital care, 244

    • public health spending trends, 25, 234–38

    • quality control in, 245–46

    • risk adjustment in, 16–17, 243–44, 249

    • sickness funds, 16, 17

    • supply restriction policies, 106

    • unification effects, 235–36

    • utilization, 167

    Global budgets

    • in Estonia, 19, 126, 330

    • in Germany, 233, 238–39, 246

    • in Hungary, 126, 334

    • in Netherlands, 192, 193

    • in Sweden, 196, 197

    • in Taiwan Province of China, 17, 128, 264, 270-71, 273

    • in Thailand, 147, 311

    Global Development Network, 314

    Global financial crisis (2008), 7, 134, 266-67

    Glucosamine, 317-19

    Governance, health system

    • basic functions of health care system, 70

    • benefits package design, 146

    • decentralization, 107, 185, 186, 187, 196-97, 340, 343

    • private sector versus government in efficiency of health care delivery, 77

    • projected health spending related to health policies, 37, 43

    • role of government in, 71, 95, 153, 283

    • strategic purchasing of services, 145-46

    • structure of Japan’s insurance system, 215-16

    • See also Institutional capacity; Public management reforms

    Greece

    • cost containment policies, 112

    • future prospects, 114-15

    • public health spending trends, 25

    H

    Health care facilities

    • accreditation program in Thailand, 311

    • capacity, international comparison of, 210t

    • in Chile, 338

    • in China, 334

    • competition among, 83

    • Estonia’s reform of, 329, 330

    • Finland’s reform of, 184

    • for-profit and not-for-profit, 71

    • Hungary’s reform of, 332

    • in India, 285-86

    • outcomes of Canada’s cost containment reforms, 182

    • ownership structure in Asia, 66-67

    • ownership structure in Germany, 244

    • in Republic of Korea, 221

    • in social insurance system, 86-87

    • in Taiwan Province of China, 263

    • in Thailand, 307

    • uncompensated care, 91

    Health care providers

    • compensation, cost of care and, 167-68

    • compensation reforms in Italy, 188, 189-90

    • competition among, 83

    • in India, 285-86, 292

    • information asymmetries in patient relationship, 79

    • international comparison of capacity and utilization, 210t

    • monopoly power, 80

    • outcomes of Sweden’s cost containment reforms, 198

    • payment system in Germany, 244–45

    • payment system in Taiwan Province of China, 264–65, 275–76

    • payment systems in East Asia and Pacific, 147–48, 152–53

    • pharmaceutical dispensing by, 223

    • resistance to reforms from, 16

    • specialization, 167, 210–11

    • structure of Republic of Korea’s health care system, 221

    • supply challenges in Estonia, 329

    • supply challenges in Hungary, 333

    • supply challenges in Mexico, 342, 345

    • supply constraints, 181, 182

    • Taiwan Province of China’s health care delivery system, 263–64

    Health care reform

    • in advanced economies, case studies of, 14–17

    • categories of, 102, 103, 178. See also specific category

    • challenges, 6, 7

    • challenges for East Asia and Pacific countries, 13

    • continuous monitoring, 111

    • cost containment efforts in advanced economies, case studies of, 101–02, 177. See also specific country

    • country-specific considerations, 6

    • econometric estimation of impacts, 120–22, 120f

    • in emerging economies, case studies of, 18–19. See also specific country

    • evidence from cross-country studies, 11-14

    • fiscal policy issues, 7–8

    • health outcomes, 157

    • interactions among reforms, 113–14

    • international comparison of health systems, 92–94, 93t

    • measures of institutional and policy performance, 118, 119t

    • need for, 4–6, 157

    • need to identify social ethics concerns for, 71–72, 73–74, 94

    • objectives, variation among emerging economies in, 12

    • production function approach to health outcomes measurement, 161–64

    • projected public health spending and, 40–42, 43, 112–18, 113f

    • resistance from interest groups, 16, 231, 253

    • role of government in, 6

    • social ethics considerations, 94–96

    • strategies for advanced economies, 121f

    • strategies for emerging economies, 126–29

    • trends in Asia, 55–56

    • trends in East Asia and Pacific, 148–53

    • window of opportunity, 273–74

    Health savings accounts, 90

    Health status

    • causes of inequality, 4–5

    • in Chile, 338–39, 339t

    • in China, 334, 335t

    • citizen satisfaction with health system, 92

    • determinants of, 34–35

    • in developing regions, 289t

    • disease profile trends, 5

    • in East Asia and Pacific, 135, 137

    • in emerging economies, 125

    • in Estonia, 327, 330

    • gross national income and, 287f

    • health spending and, 9–10, 165

    • in Hungary, 331, 331t

    • in India, 285, 286–88

    • measurement challenges, 157–58

    • in Mexico, 342, 342t

    • monitoring program in Thailand, 314–15

    • monitoring rationale, 171

    • outcomes of cost containment strategies, 116–17

    • production function approach to measurement of reform outcomes, 161–64

    • public health spending efficiency and, 29, 34–35, 157

    • in Republic of Korea, 231t

    • in Taiwan Province of China, 266

    • trends, 3

    Hong Kong Special Administrative Region

    • health care financing in, 141

    • health system inequalities in, 140

    • insurance model, 142

    Hungary

    • cost containment strategies, 334

    • cost-sharing plan, 332

    • economic indicators, 331t

    • efficiency of care, 29

    • future challenges, 332–33

    • health care delivery system, 331, 332, 333

    • health spending, 331, 332–33

    • health system financing, 331

    • insurance system, 331, 332

    • lessons from reform experience of, 333–34

    • micro-level reforms, 126

    • population health, 331, 331t

    • primary care system, 331, 332

    • provider payment system, 332, 333

    • public health spending trends, 27

    • reform experience, 19, 332

    • reimbursement system, 127

    • utilization problems, 333

    I

    Iceland, 29, 115

    Immunization rates, 168, 169f, 286

    Income growth

    • causes of increased health spending, 59–60

    • health spending and, 37, 43, 55, 236

    • health status and, 287f

    India’s health care system

    • access inequities, 284, 293, 294t

    • administrative structure, 285, 297

    • allocation of spending, 292

    • central government transfers to states, 297-99, 300-303

    • challenges, 18, 284

    • financing, 285

    • fiscal space for improvement, 299-303, 304

    • insurance scheme for poor families, 296-97

    • interstate differentials, 292-93, 293f, 297-98

    • life expectancy, 286

    • mortality outcomes, 286, 290t

    • out-of-pocket spending in, 285, 291

    • per capita spending, 291, 293, 294t, 297, 299t, 303-04

    • population health status, 285, 286-88, 289t, 290t

    • preventive care in, 286-88

    • provider compensation, 292

    • providers and facilities, 285-86, 292

    • public spending, 18, 27, 284-85, 288-93, 303-04

    • recent reforms, 284

    • reform objectives, 303

    • reform outcomes, 18

    • salient features, 284-86

    • total spending, 291

    • Union Labor Ministry insurance program, 18

    • utilization trends, 291-92

    • See also National Rural Health Mission (India)

    Indonesia

    • access to care, 57

    • contracting practices, 147

    • health care spending, 57, 139

    • health system inequalities in, 140

    • insurance model, 144, 145, 149, 151f

    • labor market, 143

    • provider payment system, 153

    Infant mortality

    • in advanced economies, 29

    • in East Asia and Pacific, 135, 135f

    • in emerging economies, 29, 125

    • in Estonia, 327

    • in Hungary, 331

    • in India, 286, 290t

    • international comparison, 286, 290t

    • in Mexico, 342

    • in Taiwan Province of China, 266

    Influenza vaccination, 161–62

    Information asymmetry, 79, 283

    Information technology

    • efficiency improvements from, 111, 116

    • in single-payer systems, 272

    • in Taiwan Province of China, 17, 265, 272

    • in Thailand, 311–12

    Institutional capacity

    • barriers to universal insurance coverage, 4

    • effectiveness of cost containment strategies in advanced economies, 102, 107–08, 108f

    • for evidence-based reform in Thailand, 18, 310–16, 322, 323

    • micro-level reforms to reduce public health spending, 103

    • strategies to improve efficiency in emerging economies, 129

    Insurance systems

    • in Asia, 56–57, 58, 60–61, 67f

    • basic functions of health care system, 70

    • benefit package design, 146

    • benefit packages in emerging economies, 127–28, 129

    • in Chile, 338, 341

    • in China, 334, 335–36

    • common models for, 60f

    • community-rated, 88–89

    • competition in, 81–83

    • drivers of health spending, 5

    • employer-based delivery, 91

    • functioning of current health care market, 80

    • in Germany, 233–34

    • health inequalities in East Asia and Pacific and, 13

    • health savings accounts, 90

    • high-deductible plans, 73, 89–90

    • hospital subsidies for uninsured, 171

    • household financial behavior and, 131

    • in Hungary, 333–34

    • in India, 18, 296–97

    • in Japan, 15, 65, 145, 212–16, 218–20

    • long-term care, 16

    • in Mexico, 341, 342–43

    • micro-level strategies to contain health costs, 12

    • need for regulation, 117

    • in Netherlands, 191

    • out-of-pocket spending, 89-90

    • premium setting, 81-82

    • regulatory trends, 80-81

    • role in improving health system efficiency, 15

    • shortcomings of current health care system, 4

    • subsidies for private insurance, 110

    • in Republic of Korea, 15-16, 221, 226-28

    • in Taiwan Province of China, 256-63

    • tax treatment of private insurance, 103, 116

    • taxes to finance benefit expansion, 129

    • in Thailand prior to universal coverage, 309, 309t

    • in two-tiered health system, 72-73

    • types of national health systems, 85, 85t, 90-92

    • in United States, 41, 90-92, 91, 95-96, 203

    • See also Asia, private insurance in; Private insurance; Social health insurance; Universal insurance coverage

    Ireland

    • future prospects, 115

    • projected outcomes of health care reform, 41

    • public health spending trends, 25

    Israel, 167

    Italy

    • cost containment policies, 112, 188-90

    • Economic and Monetary Union membership, 190-91

    • excess cost growth, 190, 190f

    • future prospects, 115

    • key health indicators, 187t

    • lessons from reform experience of, 14, 190-91

    • per capita spending, 188

    • projected outcomes of health care reform, 41

    • public health spending trends, 25, 187-88, 188f

    • structure and financing of health system, 186-87

    • supply restriction policies, 106

    J

    Japan’s health care system

    • access to care in, 210, 212

    • calculation of spending in, 15

    • care for elderly in, 15, 212, 214-15, 217, 218

    • contracting practices, 147

    • copayment rate, 65

    • cost containment policies, 112

    • cost of care trends, 214

    • current insurance market, 56, 58

    • efforts to reduce public health spending, 55

    • evolution of insurance system, 218–20

    • financial challenges, 15, 209, 214–15, 216

    • future prospects, 15, 114

    • governance structure, 215–16

    • health care resources, 210, 216

    • inequities in, 212

    • life expectancy, 29

    • medical technology capacity and utilization, 211

    • obstacles to reform, 209

    • older population in, 15

    • out-of-pocket spending, 89

    • payment system, 211

    • perceived efficiency of, 15, 216–17

    • performance of, 209

    • provider competition in, 211

    • provider privileges and practices, 210–11

    • reform needs, 217–18

    • role of private sector in, 210

    • social ethic commitments in health system, 72, 209

    • spending patterns, 56, 211–12, 211t, 216–17, 254–55

    • structure of insurance sector, 145, 212–14, 213t

    • utilization, 65, 210, 216

    • weaknesses, 209, 211, 215–16, 217–18

    K

    Korea, Republic of

    • coinsurance rates, 227

    • competition in health care system, 221

    • contracting practices, 147

    • creation of single-payer system, 222–23

    • delivery structure, 221

    • diagnostic-related groups payment system, 224

    • efficiency of care, 29, 129, 221

    • financing of health care system, 222

    • future prospects, 114-15, 230-31

    • health care financing in, 141

    • health care spending, 56, 212, 221–22, 222t, 227–28, 256

    • influenza vaccination rate, 161–62

    • insurance system, 87, 128, 145, 146, 209, 221

    • long-term care, 222, 224–26, 231

    • outcomes of cost containment efforts, 15–16

    • out-of-pocket spending, 89, 261

    • pharmaceutical cost containment strategies, 228–30, 231

    • pharmaceutical prescribing and dispensing, 223

    • pharmaceutical spending, 222

    • population health, 222, 231t

    • resistance to reforms, 16

    • social ethic commitments in health system, 72

    • sociodemographic trends, 222, 224

    L

    Labor market formality in emerging economies, 13, 129, 130, 140, 143, 148

    Lao People’s Democratic Republic

    • access to care, 57

    • health care spending, 57, 139

    • health system inequalities in, 140

    • income inequality, 135

    • insurance model, 145

    Latin America

    • health care reform goals, 12, 13

    • projected public health spending, 42

    • public insurance benefit packages in emerging economies of, 127–28, 129

    • See also specific country

    Latvia, 27

    Licensing, 80

    Life expectancy

    • in advanced economies, 29

    • in East Asia and Pacific, 135, 136f, 153

    • in emerging economies, 125

    • in Estonia, 327

    • excess cost growth projections and, 49

    • in Finland, 185

    • health spending and, 165

    • in Hungary, 331

    • in India, 286

    • inefficiencies in health spending and, 6

    • in Mexico, 342

    • in Republic of Korea, 222

    • in Taiwan Province of China, 266

    • variation among Asian countries, 57

    Lifestyle diseases, 5, 27, 276, 277, 330, 333

    London School of Hygiene and Tropical Medicine, 312, 323

    Long-term care

    • insurance, 16

    • in Republic of Korea, 222, 224-26, 225t, 231

    • in Taiwan Province of China, 277

    Luxembourg

    • cost containment policies, 112

    • future prospects, 114-15

    • infant mortality, 29

    • public health spending trends, 25

    M

    Macro-level controls to reduce public health spending

    • effectiveness in advanced economies, 105-07, 111

    • strategies, 102, 103, 177, 178. See also specific strategy

    • trends in East Asia and Pacific and, 154-55

    • unintended consequences, 102

    • Malaria prevention, 158, 159, 168-70, 169f

    Malaysia

    • health care spending, 56-57, 139

    • health system inequalities in, 140

    • insurance model, 142

    Managed care

    • copayment alternatives, 65

    • cost containment strategies, 107, 108

    • definition, 204n

    • in Germany, 245

    • rationale, 12, 62, 112

    • in United States, 108, 116, 203, 204-05, 206

    Market-oriented reforms

    • effectiveness, 108-09, 109f, 111-12

    • in Germany, 244

    • implementation, 109, 114-15

    • objectives, 103, 178

    • Sweden’s experience, 197

    • types of, 103, 178

    • in United Kingdom, 200-202

    Medicaid, 95

    • enrollment, 203

    • financing, 87

    • projected outcomes of health care reform, 41

    • social equity concerns in reimbursement, 72, 264

    Medical technology

    • administrative costs and, 265

    • capacity and utilization in Japan, 211

    • cause of increases in public health spending, 24

    • cost-effectiveness analysis in Germany, 248-49

    • cost-effectiveness analysis in Taiwan Province of China, 275

    • projected health spending related to, 37, 43

    Medicare, 79, 95

    • enrollment, 203, 205

    • fee schedule reform, 204, 205

    • financing, 87

    • projected outcomes of health care reform, 41

    Mexico

    • cost-effectiveness of health spending, 165

    • economic indicators, 342t

    • fragmentation of health care system, 19

    • future prospects, 19, 344, 345

    • health care delivery system, 341-42, 345

    • health care financing, 343, 344

    • health spending in, 342

    • immunization rate, 168

    • institutional capacity, 129

    • insurance coverage, 342-43, 344

    • insurance system, 341, 344

    • lessons from reform experience of, 19, 345

    • population health, 342, 342t

    • provider payment system, 345

    • reform experience, 343

    • reform goals, 19, 343

    • utilization, 168

    Micro-level controls to reduce public health spending

    • cost containment strategies, 12

    • effectiveness in advanced economies, 102, 107-09, 111-12

    • efficiency gains, 116–17

    • goals, 102

    • options for emerging economies, 126–27, 129

    • strategies, 102, 103, 177, 178. See also specific strategy

    Millennium Development Goals, 283–84

    Mongolia

    • contracting practices, 147

    • insurance model, 144, 145

    Monitoring of policy outcomes

    • capacity building for evidence-based reform in Thailand, 311–16

    • rationale, 111

    • revision of universal coverage package, 319–20

    Monopoly power, 80

    Morbi-RSA, 16–17, 243–44

    Mortality

    • in East Asia and Pacific, 135, 135f, 136f, 137–38

    • health spending and, 171

    • international comparison of health systems, 93–94

    • noncommunicable diseases, 5, 27n

    • in Taiwan Province of China, 266, 276

    • in Thailand, 307–08, 308f

    • See also Infant mortality

    MRI scanners, 167

    Myocardial infarction treatment, 235

    N

    National Rural Health Mission (India)

    • administration, 285

    • allocation of funds under, 295

    • components, 295

    • design and implementation problems, 18

    • establishment, 284

    • financing, 18

    • goals, 18

    • objectives, 295, 304

    • outcomes, 18, 296, 304

    • program shortcomings, 295–96

    Netherlands

    • budget cap experience, 105

    • cost containment reforms, 192–93

    • future prospects, 114

    • influenza vaccination rate, 161–62

    • insurance system, 64, 80–81, 191

    • international comparison of health systems, 92

    • key health indicators, 191t

    • lessons from reform experience of, 14–15, 194

    • out-of-pocket expenses, 238

    • physician specialization in, 167

    • price control experience, 106, 107

    • public health spending trends, 25, 191–92, 192f 193–94

    • reform outcomes, 193–94

    • structure of health system, 191

    • supply restriction policies, 106

    • total health spending, 191

    New Zealand

    • future prospects, 115

    • health care spending, 56

    • public health spending trends, 25

    Noncommunicable diseases

    • in China, 337

    • drivers of health spending, 5

    • global trends, 276

    • mortality, 5, 27n

    • in Taiwan Province of China, 276–77

    • trends in East Asia and Pacific, 154

    • trends in insurance benefit design, 146

    Norway

    • future prospects, 115

    • public health spending trends, 25

    Not-for-profit entities, 71

    O

    Obesity, 165

    Objectives of health care system

    • basic functions, 3, 69–70

    • country-specific considerations, 6

    • fairness and social ethics issues in, 70, 71–77

    • fiscal management, 7

    • private sector role in achieving, 10, 11

    • reform goals for emerging economies, 125

    • responsibility for achieving, 71

    Organization for Economic Cooperation and Development

    • capacity and utilization trends, 210

    • definition of public health spending, 234-35

    • efficiency gap among members of, 29

    • excess cost growth projections, 48

    • health care provider supply, 342

    • health spending, 179

    • indicators of health institutions and policies, 118, 119t

    • infant mortality, 342

    • insurance reform patterns, 152

    • life expectancy, 342

    • population health outcome factors, 34-35

    • public health spending among members of, 30, 31t, 195

    Out-of-pocket expenditures

    • in advanced economies of Asia, 56

    • as barrier to utilization, 55

    • in Canada, 179

    • in China, 335, 336

    • in East Asia and Pacific, 136, 139, 139f, 141, 142, 148

    • in Estonia, 327

    • in India, 285, 291

    • international comparison, 89, 211t, 212, 238, 239f

    • in Mexico, 342

    • in Republic of Korea, 226-27, 261

    • in Taiwan Province of China, 261-62

    • in Thailand, 307

    • variation by national economy, 89

    P

    Pareto efficiency, 74f 76

    Patient education to reduce utilization, 65

    Per capita spending

    • among elderly, 212

    • in Canada, 180, 181-82, 182f

    • in Chile, 339

    • in China, 291

    • in East Asia and Pacific, 57f, 138-39, 152f

    • in Estonia, 328

    • in Finland, 185

    • in Germany, 235, 236, 236f

    • health outcomes and, 165

    • in Hungary, 331

    • income levels and, 236, 237f

    • in India, 291, 293, 294t, 297, 299t, 303-04

    • international comparison, 165, 236f, 254-55, 291

    • in Italy, 188

    • in Japan, 212

    • in low-income countries, 283

    • in Netherlands, 192, 193

    • physician specialization and, 167

    • in Sri Lanka, 291

    • in Thailand, 291, 307

    • trends, 5, 23

    • See also Excess cost growth

    Pharmaceuticals system

    • cost containment reforms, 228-30, 231

    • cost-effectiveness of drugs, 158, 159

    • cost of drugs, 168

    • Dutch reform experience, 193

    • Finland’s reform experience, 185

    • in Germany, 17, 246-48

    • Italy’s reform experience, 188-89

    • per capita spending, 165

    • positive listing, 229-30

    • price controls, 16, 106-07, 228-29

    • projected outcomes of health care reform, 41

    • reference prices for generics, 17

    • in Republic of Korea, 15-16, 222, 223, 231

    • separation of prescribing and dispensing activities, 15-16, 223

    • share of public health spending, 41

    • Thailand’s reform experience, 320-22

    • United Kingdom’s reform experience, 201

    • utilization control in Thailand, 316-19

    Philippines

    • access to care, 57

    • contracting practices, 147

    • efforts to reduce public health spending, 55

    • fiscal space for reform, 151t

    • health care spending, 57, 139

    • health status, 137

    • health system inequalities, 140

    • income inequality, 135

    • insurance model, 144, 146, 149

    • provider payment system, 153

    Poland, 27

    Political functioning

    • barriers to universal insurance coverage, 4

    • health care provider resistance to reforms, 16

    • in health market reform, 253

    • need for setting social ethics goals in health care reform, 74

    • window of opportunity for health care reform, 273–74

    Pooling strategies, 144–45

    Portugal

    • cost containment policies, 112

    • future prospects, 115

    • public health spending trends, 25

    Preventive care

    • in China, 336, 337

    • in India, 285, 286–88

    • insurance benefit package design to promote, 146

    • noncommunicable diseases, 276–77

    • price incentives, 336

    • to reduce health spending, 111, 146

    Price controls

    • Canada’s reform experience, 181

    • definition and scope, 103

    • Dutch reform experience, 193

    • effectiveness in advanced economies, 102, 105–07, 107f, 112

    • Finland’s reform experience, 184

    • Italy’s reform experience, 188–89, 189

    • pharmaceutical, 16, 106–07, 228–29

    • Republic of Korea’s reform experience, 228–29

    • Sweden’s reform experience, 197

    • utilization effects, 336

    Primary care system

    • gatekeeping function, 147

    • in Hungary, 331, 332

    • in Japan, 15, 211, 217–18

    • reforms in Estonia, 328–29

    Private health spending

    • in Canada, 179

    • in Chile, 339

    • in emerging economies, 9, 23, 31

    • in Estonia, 327

    • in India, 291

    • in Italy, 188, 189

    • in Japan, 194

    • in Netherlands, 194

    • in Republic of Korea, 128, 222, 228

    • in Sweden, 194

    • in United Kingdom, 194

    • in United States, 194

    Private insurance

    • in Canada, 182

    • in Chile, 338, 340

    • in China, 334

    • in East Asia and Pacific countries, 141

    • in Germany, 73, 233–34, 239, 240–42, 248

    • in Japan, 212

    • in Netherlands, 80, 95, 194, 272

    • regulatory goals, 117

    • social equity goals and, 95, 96

    • supplementary and complementary, 110, 117, 263

    • in Switzerland, 81

    • in Taiwan Province of China, 17, 262–63

    • tax subsidies, 110

    • in Thailand, 307

    • types of national health systems, 85, 85t

    • in United Kingdom, 73, 182n

    • unregulated, 88–89

    • U.S. system, 82, 87–88, 95–96, 203, 257, 258

    Private sector

    • competition for public health insurance contracts, 87–88

    • in containment of public spending in emerging economies, 128

    • definition and scope, 71

    • functioning of health care markets, 78–81

    • versus government in efficiency of health care delivery, 77

    • market failure risk, 117

    • ownership of health care facilities, 66–67, 210, 221

    • in Republic of Korea’s health care system, 221

    • role in health care system, 10, 11, 66, 66f 71, 77–78, 117, 153

    • social equity goals and, 11, 78, 94–95

    • structure of Japan’s health care system, 210

    • types of national health systems, 85, 94-96

    • See also Private insurance

    Productive inefficiencies, 5-6, 75

    Professional associations, 80

    Projected public health spending in advanced economies, 10, 37-42, 38f, 43, 157

    • in emerging economies, 10, 42-43, 42f, 157

    • excess cost growth projections, 9, 43-49

    • fiscal challenges, 7

    • international comparison, 50-51t, 164-65, 166t

    • methodology for calculating, 8-9, 10, 39

    • population aging and, 10

    • projected outcomes of health care reforms, 40-42, 43, 112-18, 113f

    • salient policy issues, 7-8

    • sources of increase, 10, 37, 43

    • See also Public health spending

    Prospective payment systems, 107, 193, 224, 244

    Prostate cancer screening, 160, 167

    Public debt

    • health care reform challenges, 7

    • in Taiwan Province of China, 255, 272

    • Public health spending

    • in Canada, 179, 181

    • causes of increases in, 24, 30

    • in Chile, 339, 340-41

    • data sources, 30-32

    • definition, 255-56

    • demand-side strategies in advanced economies to contain, 103, 110, 110f

    • in East Asia and Pacific, 135-36, 138-39

    • economic growth and, 3-4, 129, 131

    • effectiveness of containment strategies in advanced economies, 102, 104t, 111-12

    • in Estonia, 327-28, 330

    • findings from advanced economy case studies, 14-17, 101-02

    • in Finland, 183-84, 185

    • in Germany, 234-35, 235-38

    • health outcomes of cost containment efforts, 116-17

    • hospital subsidies for uninsured, 171

    • in Hungary, 331, 332-33

    • in India, 284-85, 303-04

    • inefficiencies in, 5–6

    • inequitable allocation, 140

    • international comparison, 30, 85, 211-12, 211t, 235, 236f 288, 291, 291t

    • in Italy, 187-88, 188f

    • in Japan, 216-17

    • life expectancy and, 6

    • in low-income countries, 283

    • macro-level strategies in advanced economies to contain, 103, 105-07

    • in Mexico, 342

    • micro-level strategies in advanced economies to contain, 103, 107-09

    • monitoring program, 314-15

    • in Netherlands, 191-92, 192f, 193-94

    • preventive care to reduce, 111

    • in Republic of Korea, 221-22, 222t, 227-28, 256

    • salient issues in health care reform, 7-8

    • versus spending in other sectors, 27

    • strategies for reducing, 12, 102, 121t

    • in Sweden, 194-95

    • in Switzerland, 256

    • in Taiwan Province of China, 256

    • in Thailand, 307, 314-15

    • trends, 5, 7, 8, 23-27, 26t, 28t, 311, 32t, 33f, 34f, 101, 157, 164-65, 166t

    • in United Kingdom, 72, 199-200, 200f

    • in United States, 203-04, 204f, 256

    • value gap, 85

    • variation and convergence among advanced economies, 25-27

    • See also Projected public health spending

    Public management reforms

    • in Chile, 340

    • effectiveness, 102, 107-08, 108f

    • in Finland, 184

    • in Germany, 248-49

    • in Italy, 189

    • in Netherlands, 193

    • objectives, 178

    • in Sweden, 196-97

    • types of, 178

    • in United Kingdom, 200

    • in United States, 204-05

    • See also Contracting with private sector providers

    Q

    Quality-adjusted life-years, 70, 76, 314

    • cost-effectiveness calculations, 159–60

    Quality of care

    • access to legal recourse and, 266

    • as basis for competition among providers, 83

    • cost of care and, 83, 164

    • effects of private insurance on, 63

    • health spending and, 14, 25, 171

    • monitoring, 245–46

    • in multitiered health system, 73

    • outcomes of cost containment strategies, 116–17

    • in socialized health systems, 86

    • in two-tiered health system, 72–73

    R

    Regulation

    • basic functions of health care system, 70

    • of competition in insurance market, 95

    • of private insurance in Asia, 63–64

    • role of, 11, 117

    • in social insurance systems, 86

    • trends in insurance system reform, 80–81

    Risk management

    • community-rated health insurance, 88–89

    • in German health care system, 240–41, 243–44, 249

    • outcomes of cost containment efforts, 16–17

    • pooling of insurance funds, 144–45

    • regulatory requirements for private insurance, 64

    • in Republic of Korea’s single-payer system, 223

    • social health insurance model, 84

    • in Taiwan Province of China’s national insurance system, 257

    Romania, 27

    Rural-urban inequalities, 137–38, 322, 335–36, 337

    Russia, 27

    S

    Salt consumption, 5

    Saudi Arabia, 27

    Singapore, 56

    Single-payer system

    • advantages, 17, 182, 270–72

    • Canada’s, 86, 182

    • information technology in, 272

    • Republic of Korea’s, 221, 222–23

    • Taiwan Province of China’s, 17, 86, 253, 270–73

    • in United States, 91

    • weaknesses, 273

    • Slovakia, 114

    Slovak Republic

    • efficiency of care, 29

    • infant mortality, 29

    • life expectancy, 29

    Social health insurance, 91

    • advantages, 130

    • in Canada, 86, 87

    • disadvantages, 130

    • Dutch model, 191

    • in East Asia and Pacific, 142-43

    • in Estonia, 328, 330

    • financing, 130, 142–43

    • forms of, 86–88

    • in Germany, 86, 87

    • in Hungary, 331, 332

    • in Mexico, 343

    • rationale, 84

    • in Republic of Korea, 87

    • in Taiwan Province of China, 86, 87

    • transition to, 330

    • in United States, 86, 87–88

    Socialized medicine, 85–86

    Socioeconomic status

    • barriers to universal insurance coverage, 4

    • cause of increases in public health spending, 24

    • causes of health status inequality, 4–5

    • Chile’s economic growth, 339

    • China’s safety net program, 336

    • copayment charges and, 172

    • India’s insurance scheme for poor citizens, 296–97

    • insurance coverage for Chile’s poor, 338

    • See also National Rural Health Mission (India)

    South Africa, 29

    Spain, 115

    Sri Lanka, 291

    State Children’s Health Insurance Program, 87, 205

    Statutory health insurance, 17

    Supply constraints

    • definition and scope, 103, 178

    • effectiveness in advanced economies, 105-07, 107f, 113, 182

    • Finland’s reform experience, 184

    • input controls, 178

    • Italy’s reform experience, 189

    • output controls, 178

    Sweden

    • budget cap experience, 105

    • competition-enhancing policies, 109

    • cost containment policies, 112, 196-97

    • demand-side reforms, 110

    • excess cost growth, 197, 198f

    • future prospects, 115

    • infant mortality, 29

    • lessons from reform experience of, 15, 198

    • outcomes of cost containment reforms, 197-98

    • public health spending trends, 25, 194-95

    • spending patterns, 212

    • structure of health system, 194, 196

    Switzerland

    • cost containment policies, 112

    • efficiency of care, 29

    • future prospects, 114-15

    • insurance system, 81

    • out-of-pocket spending, 89

    • public health spending, 256

    • risk pooling in, 86

    T

    Taiwan Province of China

    • access to care, 263

    • administrative costs of national health insurance, 258, 265

    • citizen satisfaction with health system, 92, 266-67

    • competition among providers, 83, 272

    • contracting practices, 147

    • economic performance, 255

    • efforts to improve efficiency of public health system, 129

    • future challenges and opportunities, 17, 255, 274-77

    • global budget system, 128, 264, 270-71, 273

    • health care providers and facilities, 263-64

    • health status, 266

    • health system financing, 255-56, 258-62, 267-70, 268f, 274-75

    • household consumption relative to public health spending, 131

    • information technology system, 265

    • insurance system, 86, 87, 94, 145, 209, 256-63

    • lessons from reform experience of, 17, 253-54, 270-74, 278

    • life expectancy, 266

    • long-term care in, 277

    • mortality patterns, 266, 276

    • national health insurance contributions, 258-60, 260f

    • noncommunicable disease patterns and trends, 276-77

    • out-of-pocket spending, 89, 261-62

    • per capita health spending, 254, 255

    • political context of health system reform, 253

    • population aging patterns, 277

    • private sector health spending, 256

    • provider payment system, 264-65, 275-76

    • public health spending, 256

    • social ethic commitments in health system, 72, 253, 256, 271, 278

    • total national health spending, 254-55, 257, 270-71

    • utilization patterns, 260-61, 263

    • weaknesses of single-payer system, 273

    • window of opportunity for health care reform, 273-74

    Taxation

    • demand-side reforms to reduce public health spending, 110

    • to finance insurance benefit expansion, 129

    • financing of Canada’s health care system, 179

    • financing of health care in East Asia and Pacific, 143-44

    • financing of India’s health care system, 285

    • health savings accounts, 90

    • micro-level reforms to reduce public spending, 103

    • projected outcomes of U.S. health care reform, 41, 116

    • social insurance versus, 129, 130

    • subsidies for private insurance, 110

    Tertiary health care, 292

    Thailand

    • capacity building for evidence-based reform, 18, 310-16, 322, 323

    • Civil Servant Medical Benefit Scheme, 18, 309, 310, 311, 316-19

    • contracting practices, 147

    • cost containment efforts, 311

    • data collection initiatives, 314-15

    • economic performance, 307

    • global budgeting implementation, 311

    • health care financing, 307, 308-09

    • health care providers and facilities, 307

    • health spending, 56-57, 139, 152f 307

    • health status, 307-08, 308f

    • health system inequalities, 140

    • hospital accreditation program, 311

    • implementation of diagnosis-related groups, 311-12, 316

    • information management, 311-12

    • insurance benefit package reform, 18-19, 128

    • international organizations in reform process, 312, 314, 315, 323

    • lessons from reform experience of, 18, 315-16, 320-23

    • out-of-pocket spending, 307

    • pharmaceutical utilization control program, 316-19

    • population aging in, 323

    • provider payment system, 147, 152-53

    • public health spending, 27, 291, 314-15

    • research institutes, 311-14, 316, 323

    • rural medical services, 322

    • universal insurance program, 18–19, 308, 312, 319–20, 322, 323

    Tobacco use, 5, 165, 337

    Total health spending

    • in advanced economies, 23, 29–30

    • in Canada, 179

    • in Chile, 339

    • in China, 334–35

    • in East Asia and Pacific region, 136, 138

    • effect of national insurance on, 269t

    • in emerging economies, 59

    • in Estonia, 327

    • in Finland, 183

    • global budgets to control, 270–71

    • in India, 291

    • in Italy, 190

    • in Japan, 216, 217

    • in Netherlands, 191

    • in Sweden, 194

    • in Taiwan Province of China, 254–55, 257

    • in Thailand, 307

    • trends, 9, 23, 24f, 29

    • in United Kingdom, 199

    • in United States, 203

    • See also Per capita spending; Public health spending

    Transparency

    • functioning of current health care market, 79–80

    • of private insurance operations, 64

    • in reform of Thailand’s universal coverage, 319–20, 321, 323

    Turkey, 27

    U

    Ukraine, 27

    United Kingdom

    • budget cap experience, 105

    • competition-enhancing policies, 109

    • cost containment policies, 112, 200–01

    • future prospects, 115

    • health outcomes of reforms, 116

    • insurance system, 72, 73

    • key health indicators, 199t

    • lessons of reform experience, 15, 202

    • outcomes of cost containment reforms, 201-02

    • pharmaceuticals system, 201

    • physician specialization in, 167

    • projected outcomes of health care reforms, 40, 41

    • public health spending trends, 25, 199-200, 200f

    • socialized medicine in, 85-86

    • spending patterns, 212

    • structure of health system, 198-99

    United States

    • administrative costs in health system, 272

    • aspects of multitiered health system in, 73

    • citizen satisfaction with health system, 92

    • cost containment reforms, 112, 204-05

    • cost-effectiveness of health spending, 107, 165

    • cost of care, 82-83, 91, 168

    • distribution of wealth in, 84

    • efficiency of care, 29

    • excess cost growth, 205, 205f

    • future prospects, 114-16

    • health outcomes of reforms, 40, 41, 116

    • health spending patterns and trends, 203-04, 204f

    • infant mortality, 29

    • insurance coverage, 4, 89

    • insurance market, 72, 79-80, 90-92, 203

    • international comparison of health systems, 92-93

    • key health indicators, 203t

    • lessons from reform experience of, 15, 206

    • managed-care outcomes, 107

    • outcomes of cost containment reforms, 205-06

    • out-of-pocket spending, 89, 238

    • per capita health spending, 255

    • physician compensation in, 168

    • physician specialization in, 167

    • private purchase of health services by Canadians in, 72-73

    • projected health spending, 37, 38n, 40f

    • public health spending trends, 25, 164-65, 235, 256

    • shortcomings of insurance system, 96

    • social ethics concerns in health system, 72, 76-77, 270

    • socialized medicine in, 85-86, 87-88

    • uninsured population, 91

    • utilization patterns, 263

    • valuation of health care delivery in, 85

    • See also Medicaid; Medicare

    Universal insurance coverage

    • in Asia, 56, 284

    • barriers to, 4

    • in Chile, 341

    • current extent, 4

    • in East Asia and Pacific, 13-14, 149,150f

    • financing, 4, 17

    • in Japan, 212-13

    • in Mexico, 343, 344

    • outcomes monitoring, 312

    • rationale, 4, 111

    • revision of benefit design, 319-20

    • in Taiwan Province of China, 17, 257

    • in Thailand, 18-19, 308, 309, 312, 319-20, 322, 323

    • window of opportunity for implementation of, 273-74

    Utilization

    • challenges for China, 337

    • challenges for Hungary, 333

    • consumer-directed health care rationale, 90

    • copayment charges based on treatment effectiveness, 171

    • copayment effects, 65, 171, 172

    • data sources, 167

    • in developing versus developed economies, 168

    • health spending and, 165-67, 166t

    • help seeking by uninsured, 91

    • income growth and, 37, 43, 55, 59-60

    • in India, 291-92

    • international comparison, 210t

    • intracountry variation, 170

    • in Japan, 210, 216

    • monitoring program in Thailand, 314-15

    • out-of-pocket expenses as barrier to, 55

    • patient education to reduce, 65

    • price incentives, 336

    • supplier induced demand, 79

    • in Taiwan Province of China, 260-61, 263

    • in United States, 263

    V

    Value of health care, 75–76

    Veterans Administration Health Care System, 86

    Vietnam

    • access to care, 57

    • current insurance market, 57, 58

    • health care spending, 57, 139

    • health status, 137

    • health system inequalities in, 140

    • income inequality, 135

    • insurance model, 144, 149, 150f

    • provider payment system, 153

    W

    World Bank, 314

    World Health Organization, 314

    • objectives of health care system, 3

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