Background
Author (year) | Typology (countries) | Criteria |
---|---|---|
Field (1973) [20] | Pluralist healthcare (US) | Stewardship; ownership; doctors autonomy |
Health insurance (Western European countries, Japan) | ||
National health service system (UK) | ||
Socialist healthcare system (USSR, Eastern Europe) | ||
OECD (1987) [21] | Beveridge model (UK, Nordic countries, Southern European countries, Ireland) | Coverage; funding; ownership |
Bismarck model (Austria, Belgium, France, Germany, Luxembourg, Netherlands) | ||
Private insurance (US) | ||
Donalson and Gerard (1993) [22] | Tax funding (Denmark, Norway, Sweden, UK) | Funding |
Social insurance contributions (France, Germany) | ||
Mixed systems (Italy, Spain, Netherlands) | ||
European Parliament (1998) [3] | Main/supplementary system: Public taxation/private VHI and direct payments (Finland, Greece, Ireland, Italy, Sweden, Spain, UK) | Funding |
Public taxation/direct payments (Denmark, Portugal) | ||
Social contributions insurance/private VHI, direct payments, public taxation (Austria, Belgium, France, Germany, Luxembourg) | ||
Mixed compulsory social insurance and private voluntary health insurance/public taxation, direct payments (Netherlands) | ||
WHO (1997) [23] | Beveridge model, mainly taxed based (Denmark, Finland, Iceland, Ireland, Norway, Sweden, UK) | Funding |
Bismarck model, mainly insurance based (Austria, Belgium, France, Germany, Luxembourg, Netherlands, Switzerland) | ||
Mixed system: 3 sub-groups are considered: Systems in transition, mainly Bismarkian type (Israel, Turkey) | ||
Systems in transformation I from insured to taxed system (Greece, Italy, Portugal, Spain) | ||
Systems in transformation II from Semasko to insured system (ex-communist countries) | ||
Tuohy (1999) [24] | National health service (UK) | Modes of social control: hierarchy; ollegiality; market |
Social insurance (Canada) | ||
Private insurance (US) | ||
Moran (2000) [25] | Entrenched command and state control (Scandinavia, UK) | Consumption; provision; technology |
Supply state (US) | ||
Corporatist state (Germany) | ||
Insecure command and control state (Greece, Italy, Portugal) | ||
National health service (Italy, Sweden, UK) | Financing; delivery; regulation | |
Social insurance system (France, Germany) | ||
Docteur and Oxley/ OECD (2003) [28] | Public-integrated model (Nordic countries, Italy, Greece, Portugal) | Relations across providers; payers; users |
Public-contract model (Continental European countries, UK) | ||
Private insurance/provider (Switzerland, US) | ||
Thompson et al. (2009) [6] | Social insurance (Austria, Belgium, Czech Republic, Estonia, France, Germany, Lithuania, Luxembourg, Netherlands, Poland, Romania, Slovakia, Slovenia, Bulgaria) | Funding |
Taxed financed (Denmark, Finland, Ireland, Italy, Malta, Portugal, Spain, Sweden, UK) | ||
Out-of-pocket payments (Cyprus, Greece, Latvia) | ||
Wendt (2009) [9] | Health service provision oriented (Austria, Belgium, France, Germany, Luxembourg) | Healthcare expenditure; financing; provision; institutional characteristics |
Universal coverage controlled access (Denmark, UK, Sweden, Italy, Ireland) | ||
Low budget restricted access (Portugal, Spain, Finland) | ||
National health service (Denmark, Finland, Norway, Sweden, Portugal, Spain, UK) | Financing; provision, regulation | |
National health insurance (Ireland, Italy, Canada) | ||
Social based mixed (Slovenia) | ||
Social Health Insurance (Austria, Germany, Luxembourg, Switzerland) | ||
Private healthcare system (US) | ||
Statist social health insurance (Belgium, Estonia, France, Czech Republic, Hungary, Netherlands, Poland, Slovakia, Israel, Japan) | ||
Northern macro-region (Sweden, Norway, Finland, Denmark, UK, Ireland) | Neighborhood; one common feature | |
Center Western macro-region (France, Germany, Austria, Netherlands, Belgium, Luxembourg) | ||
Center Eastern macro-region (Poland, Czech Republic, Slovakia, Hungary, Slovenia, Estonia, Lithuania) | ||
Southern macro-region (Italy, Spain, Portugal, Greece) | ||
Joumard et al. (2010) [10] | Private provision and private insurance for basic coverage (Germany, Netherlands, Slovakia, Switzerland) | Institutions; regulations; policies |
Private provision, public insurance for basic coverage, private insurance beyond basic coverage and some gate-keeping (Belgium, France) | ||
Private provision, public insurance for basic coverage, little private insurance beyond basic coverage and no gate-keeping (Austria, Czech Republic, Greece, Luxembourg) | ||
Public provision and public insurance, no gate-keeping and ample choice of providers (Iceland, Sweden) | ||
Public provision and public insurance, gate-keeping, limited choice of providers and soft budget constraint (Denmark, Finland, Portugal, Spain) | ||
Public provision and public insurance, gate-keeping, ample choice of providers and strict budget constraint (Hungary, Ireland, Italy, Norway, Poland, UK) | ||
Reibling (2010) [7] | Financial incentives states (Austria, Belgium, France, Sweden, Switzerland) | Gatekeeping; cost-sharing; provider density; medical technology |
Strong gatekeeping and low supply states (Denmark, Netherlands, Poland, Spain, UK) | ||
Weakly regulated and high supply states (Czech Republic, Germany, Greece) | ||
Mixed regulation states (Finland, Italy, Portugal) | ||
EU (2012) [32] | Decentralized (Austria, Italy, Spain) | health funding by Local and Regional Authorities (LRA); power and responsibility by LRA with regard to health-related legislative, planning, and implementation functions; ownership and management of health care facilities by LRA |
Partially decentralized - funding level above EU average (Denmark, Estonia, Finland, Lithuania, Poland, Sweden, Hungary) | ||
Partially decentralized - funding level below EU average (Belgium, Czech Republic, Germany) | ||
Operatively decentralized - funding level below EU average (Bulgaria, Latvia, Luxembourg, Romania, Slovakia, Slovenia) | ||
Operatively decentralized - funding level low or null (Netherlands, UK) | ||
Centralized but structured at territorial level (France, Greece, Portugal) | ||
Centralized (Cyprus, Ireland, Malta) |
Conceptual framework
Methods
Data and variables
Acronym | Description | Source |
---|---|---|
HD | Hospital discharges due to diabetes, hypertension or asthma (per 100,000 inhabitants). It is the formal release of a patient from a hospital after a procedure or treatment. It can refer to inpatients or day cases. | (1) |
MD | Medical doctors (per 100,000 inhabitants), health professionals who study, diagnose, treat and prevent illness, disease, injury and other physical and mental impairments in humans through the application of the principles and procedures of modern medicine. They plan, supervise and evaluate the implementation of care and treatment plans by other health care providers and conduct medical education and research activities. | (1) |
THE | Total health expenditures per capita (PPS$), i.e. the sum of public and private expenditure on health. | (2) |
THEG | Total public health expenditures per capita (PPS$), i.e. the health expenditures from the public sector, including health maintenance, restoration or enhancement paid for in cash or in kind by government entities, transfer payments to households to offset medical care costs and extra-budgetary funds to finance health. | (2) |
OOP | Out-of-pocket payments, i.e. private households’ out-of-pocket payment on health (% of total health expenditure), including gratuities and payments in-kind made to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services, whose primary intent is to contribute to the restoration or to the enhancement of the health status of individuals or population groups, and including household payments to public services, non-profit institutions or non-governmental organizations. | (2) |
Acronym | Description | Source |
---|---|---|
GDP | Gross Domestic Product per capita (PPS$), i.e. a measure of the economic activity and of the wealth of a country. | (1) |
Real GDP Growth rate | The growth rate of the GDP in terms of volume (%), values determined by the prices of the previous year, and thus computed volume changes are imposed on the level of a reference year so that price movements will not inflate the growth rate. | (2) |
Government Debt | General government gross debt (% of GDP, million EUR). | (1) |
U | Unemployment rate (%), i.e. the percentage of unemployed people in the active population. | (3) |
Acronym | Description | Source |
---|---|---|
PM | Premature mortality (standardized death rate), i.e. the mortality taking place before the age of 65 (the age limit used in the bulk of international work) in a 3-year period. | (1) |
LEB | Life expectancy at birth, i.e. the average number of years that a new-born could expect to live if he/she were to pass through life exposed to the age-specific death rates prevailing at the time of birth, for a specific year, in a given country, territory or geographical area. | (2) |
IM | Infant mortality, i.e. the ratio of the number of deaths of children under one year of age during the three-year period to the number of live births in that period. | (2) |
DALY | Disability Adjusted Life Years adjusted for differences in the age distribution of the population, and expressed in per 100,000 people. One DALY represents the loss of the equivalent of one year of full health. DALYs for a disease or health condition are the sum of the years of life lost to due to premature mortality (YLL) and the years lived with a disability (YLD) due to prevalent cases of the disease or health condition in a population. | (3) |
Statistical analysis
Results
Step 1: Factor analysis
HD | THE | OOP | THEG | |
---|---|---|---|---|
MD | 0.114 (p = 0.614) | 0.069 (p = 0.726) | 0.189 (p = 0.335) | 0.038 (p = 0.846) |
HD | −0.411* (p = 0.034) | 0.320 (p = 0.110) | −0.384* (p = 0.050) | |
THE | −0.602** (p = 0.001) | 0.988** (p < 0.001) | ||
OOP | −0.677** (p < 0.001) |
Factor 1 | Factor 2 | Factor 3 | |
---|---|---|---|
THEG | 0.957 | 0.090 | −0.193 |
THE | 0.923 | 0.141 | −0.239 |
OOP | −0.815 | 0.295 | 0.080 |
MD | 0.001 | 0.976 | 0.061 |
HD | −0.227 | 0.072 | 0.969 |
Eigenvalue | 2.765 | 1. 089 | 0.746 |
% of Variance | 55.3 | 21.8 | 14.9 |
Step 2: Cluster analysis
Step 3: General description of clusters
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Socioeconomic characteristics
Cluster | GDP a | RGDPgr b | U c | GD d |
---|---|---|---|---|
Austria-Germany | 33,521.80 | 0.30 | 5.30 | 80.60 |
Central and Northern Countries | 36,391.18 | 0.92 | 8.09 | 69.20 |
Southern Countries | 22,911.43 | 1.58 | 16.63 | 106.8 |
Eastern Countries ‘A’ | 16,749.97 | 2.43 | 10.1 | 44.37 |
Eastern Countries ‘B’ | 19,496.12 | 0.4 | 9.9 | 46.56 |
-
Health outcome indicators
Cluster | PMa | LEBb | IMc | DALYd |
---|---|---|---|---|
Austria-Germany | 201.50 | 81.10 | 3.38 | 19,493.50 |
Central and Northern Countries | 199.92 | 81.34 | 3.33 | 19,410.78 |
Southern Countries | 175.88 | 82.13 | 3.54 | 18,113.17 |
Eastern Countries ‘A’ | 423.73 | 75.15 | 6.22 | 35,705.33 |
Eastern Countries ‘B’ | 316.96 | 78.24 | 3.31 | 23,860.00 |