Healthcare System Types: A Conceptual Framework for Comparison

This article addresses the need to establish a comprehensive conceptual framework for analysing healthcare systems and their transformations. It begins by offering an overview of the current state of the art in the field, pointing to the literature's absence of conceptual robustness in the definition of system types. By exploring the dimensions ‘financing’, ‘provision’ and ‘regulation’ of healthcare, the article then proceeds deductively in line with the ‘Weberian method of ideal-types’ to establish a taxonomy of 27 healthcare systems, of which three can be identified as ‘ideal-types’. When applying this concept, not only can differences between healthcare systems be analysed, but also changes over time. The article concludes by identifying three forms of healthcare system transformation.

[1]  Richard B. Saltman,et al.  Organizational restructuring in European health systems: the role of primary care. , 2003 .

[2]  Mark Schlesinger The challenge of tracking whales: lessons from the study of changing health policy. , 2005, Journal of health politics, policy and law.

[3]  M. Field,et al.  The concept of the "health system" at the macrosociological level. , 1973, Social science & medicine.

[4]  Elias Mossialos,et al.  Plus ça change: health sector reforms in Greece. , 2005, Journal of health politics, policy and law.

[5]  C. Wendt,et al.  Social Austerity versus Structural Reform in European Health Systems: A Four-Country Comparison of Health Reforms , 2004, International journal of health services : planning, administration, evaluation.

[6]  Bruno Palier,et al.  Towards Neo‐Bismarckian Health Care States? Comparing Health Insurance Reforms in Bismarckian Welfare Systems , 2007 .

[7]  C. Wendt,et al.  9 The changing role of the state in healthcare systems , 2005, European Review.

[8]  P. Hall Policy paradigms, social learning, and the state: the case of economic policymaking in Britain , 1993 .

[9]  G. Schieber,et al.  Overview of international comparisons of health care expenditures , 1989, Health care financing review.

[10]  August Österle,et al.  Health care across borders , 2007 .

[11]  Robert H. Blank,et al.  Comparing health policy: An assessment of typologies of health systems , 2006 .

[12]  C. Wendt Krankenversicherung oder Gesundheitsversorgung , 2003 .

[13]  Manos Matsaganis,et al.  Testing the 'social dumping' hypothesis in Southern Europe: welfare policies in Greece and Spain during the last 20 years , 2000 .

[14]  P. Manow,et al.  Adapting the Welfare State , 1999 .

[15]  Clare Bambra,et al.  Cash Versus Services: ‘Worlds of Welfare’ and the Decommodification of Cash Benefits and Health Care Services , 2005, Journal of Social Policy.

[16]  L Cabiedes,et al.  Adopting and adapting managed competition: health care reform in Southern Europe. , 2001, Social science & medicine.

[17]  E. Shils,et al.  The Methodology Of The Social Sciences , 1949 .

[18]  M. Weber Methodology of Social Sciences , 1949 .

[19]  R. Freeman,et al.  The Politics of Health in Europe , 2000 .

[20]  A. Culyer,et al.  Cost Containment in Europe , 1989, Health care financing review.

[21]  Michael Moran,et al.  Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada , 1999 .

[22]  Clare Bambra,et al.  The worlds of welfare: illusory and gender blind? , 2004, Social Policy and Society.

[23]  M Terris,et al.  The three world systems of medical care: trends and prospects. , 1978, American journal of public health.

[24]  Claus Wendt,et al.  Krankenversicherung oder Gesundheitsversorgung? : Gesundheitssysteme im Vergleich , 2003 .

[25]  Clare Bambra,et al.  Health Status and the Worlds of Welfare , 2006, Social Policy and Society.

[26]  J. Bury The politics of health in Europe , 2000, International Journal of Integrated Care.

[27]  Robert H. Blank,et al.  Comparative Health Policy , 2004 .

[28]  Michael Moran,et al.  Reforming health care in Europe , 2000 .

[29]  W. Korpi,et al.  New Politics and Class Politics in the Context of Austerity and Globalization: Welfare State Regress in 18 Countries, 1975–95 , 2003, American Political Science Review.

[30]  A Donabedian,et al.  State intervention in medical care: types, trends and variables. , 1987, Health policy and planning.

[31]  Terkel Christiansen,et al.  Health policy in Denmark: leaving the decentralized welfare path? , 2005, Journal of Health Politics Policy and Law.

[32]  Giandomenico Majone,et al.  From the Positive to the Regulatory State: Causes and Consequences of Changes in the Mode of Governance , 1997, Journal of Public Policy.

[33]  B. Ebbinghaus,et al.  Can Path Dependence Explain Institutional Change? Two Approaches Applied to Welfare State Reform , 2005 .

[34]  Uwe Helmert,et al.  Convergence of divergence of OECD health care systems , 2004 .

[35]  Stephan Leibfried,et al.  Towards a European welfare state , 2002 .

[36]  C. Wendt,et al.  Transformations of the State?: The changing role of the state in healthcare systems , 2005 .

[37]  Paul Pierson,et al.  Coping with Permanent Austerity: Welfare State Restructuring in Affluent Democracies , 2002 .

[38]  Michael Moran,et al.  Review Article: Understanding the Regulatory State , 2002, British Journal of Political Science.

[39]  Herbert Obinger,et al.  The State and its Welfare State: How do Welfare State Changes Affect the Make‐up of the Nation State? , 2006 .

[40]  J. Alber,et al.  A Framework for the Comparative Study of Social Services , 1995 .

[41]  Martin McKee,et al.  Health and health care in the candidate countries to the European Union: common challenges, different circumstances, diverse policies , 2004 .

[42]  Carolyn J. Tuohy,et al.  Agency, Contract, and Governance: Shifting Shapes of Accountability in the Health Care Arena , 2003, Journal of health politics, policy and law.

[43]  W. Korpi,et al.  Welfare-State Regress in Western Europe: Politics, Institutions, Globalization, and Europeanization , 2003 .

[44]  R. Klein,et al.  The New Politics of the NHS , 2013 .

[45]  Steven S. Sharfstein,et al.  Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada , 2001 .

[46]  Jürgen Kohl,et al.  Der Wohlfahrtsstaat in vergleichender Perspektive , 1993 .

[47]  C. Wendt,et al.  Translating Monetary Inputs into Health Care Provision: A Comparative Analysis of the Impact of Different Modes of Public Policy , 2010 .

[48]  Carolyn Hughes Tuohy Canada Health Care Reform in Comparative Perspective , 2009 .

[49]  R. Klein,et al.  Carolyn Hughes Tuohy, Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain and Canada, New York: Oxford University Press pp. X + 312. ISBN 0–19–512821–4 $45 , 2000, Journal of Public Policy.

[50]  F. Block,et al.  Social Foundations of Postindustrial Economies , 2001 .

[51]  Joseph White,et al.  Markets and Medical Care: The United States, 1993-2005 , 2007, The Milbank quarterly.

[52]  Michael Moran,et al.  Understanding the Welfare State: The Case of Health Care , 2000 .