Because the risk of ill health is part of the human condition, there is a universal interest in providing access to high-quality healthcare while controlling the sacrifices that are necessary to obtain it – after all, the funds used for healthcare cannot be allocated to alternative uses. Affordability is therefore an important consideration that is closely linked to access. Quality determines the health value of the treatment provided. Arriving at a social consensus on how to achieve these goals is difficult, however, which in most countries leads to intense debate on healthcare, as the contributions to this book regarding the US, South Africa, Colombia and the Netherlands all illustrate. Unsurprisingly, there is no one particular healthcare system that meets all three of the needs identified above perfectly. Instead, there is a wide variety of such systems, each with different advantages, disadvantages and trade-offs. Hence it is important that data on the problems encountered are collected and analysed, and that learning occurs between different health systems. This is a practical as well as a scientific challenge, because hitherto most studies on healthcare regulation have not taken a comparative perspective based on comparable data. In fact, in many respects, no such data yet exists. This book charts hospital financing across the three dimensions of access, affordability and quality. It does so based on an international comparison spanning four different continents. For the purpose of our project, we have collected 11 country reports, compiled by national experts according to a standard structure. In addition, six thematic chapters are included that explore specific questions. The invited authors include academics and practitioners (primarily, but not exclusively, policymakers).
Jos Boertjens, Johan van Manen, Misja Mikkers and Wolf Sauter
William M. Sage
In this chapter the author explains the enormous waste in the US Healthcare System and the little progress that has been made to achieve efficiency and fairness. To large extent the ‘deep legal architecture’ – the accumulation laws, regulations, self regulatory practices and subsidies – prevents meaningful competition in medical markets. Three areas of improvement are described. First, there is a great urgency to restructuring payment methods for health care delivery, in order to improve efficiency. Second, barriers to market entry in health care markets should be broken down, collusion between health care providers to divide markets and exclusion of new competitors should be prevented to ensure meaningful competition. Third, investment in combatting poverty, lack of education and substandard housing may lead to less costly and more effective health care.
This chapter introduces the theme of the book. In this context, it looks at the variety of approaches taken by regulators around the globe with respect to e-cigarettes, as well as at the science that stands behind specific regulatory choices. It also delimits the scope of the book and clarifies terminological nuances. Against this background, the chapter summarizes and critically assesses the findings of the individual authors relating to: (i) the factors that influence the particular paths taken in different jurisdictions; (ii) general features of an optimal regulatory model for e-cigarettes; and (iii) constraints imposed by international and European rules on regulators in this policy space. The chapter also offers some general observations as to the possible future directions of e-cigarette regulation.