Healthcare

Market Dynamics, Policies and Strategies in Europe

Mario Glowik, Slawomir Smyczek, Mario Glowik, Slawomir Smyczek

• Publisher: De Gruyter Oldenbourg
• Year: 2015
• Print ISBN: 9783110553888
• eBook ISBN: 9783110414912
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Emerging challenges related to socio-demographics and economics require new approaches for academics, politicians, hospital management, clinical staff, public institutions, and firms doing business in the healthcare industries.

This book provides valuable insights for understanding modern and complex healthcare market configurations in Europe.

Taking a unique cross-country perspective the authors figure out critical success factors for relevant stakeholders.

Mario Glowik is Professor of International Strategic Management at the Berlin School of Economics and Law. He holds a Doctorate in Business Administration from the Freie Universität Berlin in Germany and gained his habilitation (post-doctoral qualification) at the Vienna University of Economics and Business, Austria.

Slawomir Smyczek is Marketing Professor at the University of Economics in Katowice (Poland), where he earned his Ph.D. In 2010, the Polish Prime Minister awarded his habilitation thesis as the best in the field of economics in the entire country.

Justyna Matysiewicz

1 Introduction to the European Healthcare Market

Abstract: The Member States of the European Union have adopted different approaches to the organization of health systems in their countries. These systems have different forms of financing and also have different levels of efficiency. This chapter presents detailed characteristics of the major health systems in the European Union and discusses the sources of financing for these systems, including the additional, voluntary forms of insurance. In particular, the chapter describes and characterizes Belgian, German, Polish, Swedish, and UK systems. The chapter also presents the results of patient surveys used in the health systems.

Keywords: Healthcare system, Financing healthcare, European market

1.1 Introduction

Every healthcare system is focused on meeting the health needs of a particular population. The real level and degree of meeting these needs is determined by a number of elements, in particular by the means at the disposal of the system. The result of system activities should be improvement of the health status of the population, or at least should keep health outcomes at a constant level. The particular healthcare systems in the European Union countries are related to the history, tradition, and culture of the given country. Nevertheless, there are a few main healthcare models, which differ from one another in methods of financing, organization, and efficiency. This chapter describes the main types of healthcare models in the EU, discusses expenditures on health by the individual countries and the role of private health insurance, and presents opinions of patients regarding the health systems.

1.2 Concept of the healthcare system

Equality in access to health services is one of the main rights of people, and its assurance should be the primary objective of the healthcare system. The health policy of each country1 and the WHO2 should aim, therefore, to achieve this objective through an appropriate regulatory system that takes into account financial and structural needs and promotes the principles of bioethics (equality in access to healthcare for people with identical health needs, ensuring the same quality of medical services and the same use of resources and effort in pursuit of patient health) (Suchocka 2008).

Health protection refers to a wide range of social activities undertaken by public health departments and government agencies, whose aim is to prevent and treat diseases, improve mental and physical health, extend human life, and ensure the healthy development of the next generation (Encyclopedia 1999). In contrast, healthcare can be defined as a system of healthcare facilities and the services provided by them. The aim is to strengthen and improve the health of individuals and society through disease prevention, early detection, treatment, and rehabilitation (Encyclopedia 1999). The purposes of this system are the following (Poznański et al. 2000, Wlodarczyk 1996):

– providing the entire population the full range of required medical services without regard to their economic, social, cultural, and geographical status (access to care);

– providing services and benefits, preventive treatment, and rehabilitation at the highest possible level, given the level of knowledge and art of medicine and the principles of good practice (quality of medical care in accordance with the principles of its continuity and a global approach);

– organization of care in the best possible way, so as to ensure optimum use of resources – financial, personal, and technological such as health databases (effectiveness of healthcare – productivity, rationality, efficiency);

– systematic implementation of activities that improve the system; and employment of appropriate personnel prepared to work in healthcare.

The health system differs from other social systems, such as education, and from the markets for most consumer goods and services in two ways, which make the goals of fair financing and responsiveness particularly significant. One difference is that healthcare can be very costly. Much of the need for care is unpredictable, so it is vital for people to be protected from having to choose between financial ruin and loss of health. Mechanisms for sharing risk and providing financial protection are more important than in other situations where people buy insurance, as for physical assets like homes or vehicles or the financial risk to a family of a breadwinner dying young. The other peculiarity of health is that illness and medical care as well can threaten people’s dignity and their ability to control what happens to them more than most other events to which they are exposed. Among other things, responsiveness means reducing the damage to one’s dignity and autonomy and reducing the fear and shame that sickness often brings with it (The World Health Report 2000).

Therefore, it is assumed that the basic objectives of the healthcare system include eliminating health inequalities by ensuring equal opportunities for development and health; strengthening health; preventing disease, death and disability; and organizing the treatment to be provided so as to ensure both care for the patient and the preservation of patient dignity.

Fig. 1.1: Relationship between the functions of the health system and its goal

Source: Adapted from The World Health Report, Health Systems. Improving Performance, WHO 2000p. 25

1.3 Healthcare systems in the EU

European societies recognize that a good healthcare system should be accessible to everyone, regardless of their income. Free choice and equal access to health services for all (or the vast majority of the population) is the primary goal of each system. Due to limited resources and their nature (public), and in particular the existing disparity between resources and the needs of society, the healthcare system should use tools that enable maximum efficiency in both micro- and macro-scales. The tools used to achieve this efficiency are the different forms of organization and ownership of healthcare units, sources and methods of financing healthcare services, and methods of payment for medical services – from public funds or the private funds of patients (Jasinski 2002).

The systems chosen by European countries are different. This difference relates primarily to the method of financing healthcare in the country and the forms of its organization (Siwinska 2008).

Traditional models of healthcare systems are treated as patterns that describe the desired or the ideal shape of the system. The models constitute a set of possible solutions, from which countries can choose those that are thought to be the best given their circumstances. Individual countries adapt the model to their own circumstances on an individual basis, i.e. they decide to apply only certain elements that are appropriate to the situation in their country. The most common European models of health systems are

– Bismarck’s model (insurance model of healthcare financing);

– Beveridge’s model (supply model of healthcare financing);

– Residual model, called the X model; and

– Siemaszko’s model (after the collapse of the communist system, this model is not present in any European country).

These models have a universal character because of the possibility of their use in the analysis of the health policies and systems of different countries. At the same time, they show some specifics related to the development of systems that proceeded differently in the UK, Germany, the countries of Central and Eastern Europe, and Scandinavia. Other countries, utilizing one of these models to a greater or lesser extent, proceeded in their own way, a process in which tradition and history played a very important role (Klos et al. 2005).

Finance and organization of healthcare in the EU Member States is based on national political and socio-economic traditions. These traditions translate into certain social objectives in healthcare finance and delivery, such as equity, efficiency, and affordable cost. There is considerable variation both among healthcare systems in the EU and in healthcare and other policy sectors within each country in the relative value assigned to each objective.

To finance a healthcare system, money has to be transferred from the population or patient, the first party, to the service provider, the second party. All systems in the European Union employ a third party to pay for or to insure health expenses for beneficiaries for the times when they are patients. The aim is to share the costs for medical care between the sick and the well and to adjust for different levels of ability to pay. This mechanism of solidarity reflects consensus in the European Union that healthcare should not be left to a free market alone (European Parlament 1998).

Discussing more particularly the healthcare systems implemented in Europe requires starting with Bismarck’s model, which was introduced by Prince Otto Eduard Leopold von Bismarck in 1883. This model became the template for creating insurance in almost all European countries in the early twentieth century. Healthcare services are financed from premiums (paid by the employee and the employer), which are most often obligatory. The process of making decisions is decentralized, and the state creates precise legal frames of functioning for the entire system. The important thing is that funding medical care costs may be prov...

Table of contents

• Cover
• Title
• Copyright
• Preface
• Contents
• Justyna Matysiewicz
• Jagoda Gola
• Artur Turek and Aleksander Owczarek
• Agnieszka Hat
• Sławomir Smyczek
• Thuy Nguyen and Mario Glowik
• Marta Grybś
• Beatrix Dietz and Andreas Zaby
• Agnieszka Marie
• Justyna Matysiewicz
• Marcin Młodożeniec
• Sławomir Smyczek
• Marcin Tutaj
• Endnotes
• About the Authors
• Index