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Bismarck or Beveridge: a beauty contest between dinosaurs.
Zee, J. van der. Bismarck or Beveridge: a beauty contest between dinosaurs. European Journal of Public Health: 2006, 16(Suppl. 1) 15. Abstract. 14 th Eupha conference "Politics, Policies and /or the Public's Health", Montreux, 16-18 November 2006.
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Background: Health care delivery systems usually are, roughly, subdivided into two groups: Social Security Health care systems (SSHs), originally founded by Bismarck, and National Health Services systems (NHS), founded by Beveridge. Besides differences in the way they are funded (taxation based versus earmarked premiums), they differ in the way they are governed and the way services can be accessed (secondary care directly accessible or via referral), although there is some tendency to convergence and exceptions confirm the rule. Evidence, however, about the ‘performance’ of the two types of systems is inconclusive, mostly because the number of countries is low, and analyses are too complicated. Therefore, this paper tries to compare SSHs and NHSs in Europe on a set of generally accepted indicators in the domain of ‘health’, ‘health care expenditures’, and ‘user evaluation’. Methods: The country selection was based on the work of Saltman, Busse and Figueras (2004). However, we excluded Israel in order to limit the analysis to Europe. So 18 countries remained (7 SSH and 11 NHS). The concept ‘health’ was specified as age standardized mortality rates (SMRs) and life expectancy at birth. ‘Health care expenditures’ was expressed as expenditure per capita and percentage of GDP spent on health and ‘user evaluation’ as percentage of population satisfied with their health care system. For each indicator time series (1970– 2002/4, for user evaluation 1996–1999) were compared. For 1990 and 2000 unweighted averages were displayed, too. Results: Health: SMRs in SSHs are on average ±15% lower than in NHS systems, although the most recent years show some convergence. In average life expectancy at birth the differences between the two groups are negligible over the years. Health care expenditures: SSH systems are considerably more expensive than NHS systems, especially regarding per capita spending (SSH, 1990 50% higher; 2000 34% higher). Spending as percentage of GDP fluctuates more but in 1990 SSH systems were 16% more expensive and in 2000 12%. User evaluation: Here SSH systems have much higher rates (SSH 52% higher in 2000) of satisfied citizens, although the time series are much more limited here. Conclusions: Social Security based health care systems spend considerably more money on their health care systems and are much more positively evaluated by their citizens. Regarding the production of ‘health’ the results are less unequivocal: life expectancy does not differ but age-standardized death rates do (in favour of SSH systems). So are the better death rates and higher user-satisfaction worth the extra costs? The answer is to the audience (and, of course, to the citizens of Europe). (aut. ref.)
Background: Health care delivery systems usually are, roughly, subdivided into two groups: Social Security Health care systems (SSHs), originally founded by Bismarck, and National Health Services systems (NHS), founded by Beveridge. Besides differences in the way they are funded (taxation based versus earmarked premiums), they differ in the way they are governed and the way services can be accessed (secondary care directly accessible or via referral), although there is some tendency to convergence and exceptions confirm the rule. Evidence, however, about the ‘performance’ of the two types of systems is inconclusive, mostly because the number of countries is low, and analyses are too complicated. Therefore, this paper tries to compare SSHs and NHSs in Europe on a set of generally accepted indicators in the domain of ‘health’, ‘health care expenditures’, and ‘user evaluation’. Methods: The country selection was based on the work of Saltman, Busse and Figueras (2004). However, we excluded Israel in order to limit the analysis to Europe. So 18 countries remained (7 SSH and 11 NHS). The concept ‘health’ was specified as age standardized mortality rates (SMRs) and life expectancy at birth. ‘Health care expenditures’ was expressed as expenditure per capita and percentage of GDP spent on health and ‘user evaluation’ as percentage of population satisfied with their health care system. For each indicator time series (1970– 2002/4, for user evaluation 1996–1999) were compared. For 1990 and 2000 unweighted averages were displayed, too. Results: Health: SMRs in SSHs are on average ±15% lower than in NHS systems, although the most recent years show some convergence. In average life expectancy at birth the differences between the two groups are negligible over the years. Health care expenditures: SSH systems are considerably more expensive than NHS systems, especially regarding per capita spending (SSH, 1990 50% higher; 2000 34% higher). Spending as percentage of GDP fluctuates more but in 1990 SSH systems were 16% more expensive and in 2000 12%. User evaluation: Here SSH systems have much higher rates (SSH 52% higher in 2000) of satisfied citizens, although the time series are much more limited here. Conclusions: Social Security based health care systems spend considerably more money on their health care systems and are much more positively evaluated by their citizens. Regarding the production of ‘health’ the results are less unequivocal: life expectancy does not differ but age-standardized death rates do (in favour of SSH systems). So are the better death rates and higher user-satisfaction worth the extra costs? The answer is to the audience (and, of course, to the citizens of Europe). (aut. ref.)