Learning from Innovation in the Health Industry
Edited by Marco R. Di Tommaso and Stuart O. Schweitzer
Chapter 3: Control, Competition and Co-operation in European Health Systems: Points of Contact Between Health Policy and Industrial Policy
Giovanna Vicarelli 1 FOREWORD The health policies that have been adopted in Europe in the last 20 years have been labelled ‘restrictive’ in order to distinguish them from ‘expansive’ policies which characterized the previous decades. The increase in health expenditures in Europe in the 1970s, together with the growing concern about the economic sustainability of an expanding sector, drove all European countries to develop speciﬁc strategies aimed at reducing and containing both the provision of and the demand for health services. Given the wide variety of choices, it is diﬃcult to evaluate properly these restrictive policies. As a matter of fact, while a few countries have limited the provision of services, some have increased taxation and some others have decentralized the responsibility for health expenditure. However, in spite of national diﬀerences depending on the history of each country’s health system, many authors agree on the identiﬁcation of a certain degree of convergence on policy implementation. In analysing these forms of convergence three main policies can be identiﬁed which correspond to three diﬀerent approaches for the regularization and social organization of the health sector. The ﬁrst policy, which is analysed in the third section, consists of a top-down intervention in which the government and public bodies cut down and limit health expenditure, acting at a macroeconomic level. In the second (explained in the fourth section), equilibrium factors are sought at a microeconomic level. In particular an attempt is made to introduce forms of ‘managed competition’...
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