Towards Sustainable Health Care Systems

As the population ages, there will be increasing pressure on controlling the costs of medical and long-term health care and on the quality of care. Countries that provide health care protection through social insurance are taking a variety of approaches to address these impacts. This study compares four countries which all have social health insurance systems based on the Bismarckian approach: France, Germany, Japan and the Netherlands. The study is divided into three sections. The first section compares the institutional and organizational framework of social health insurance in these countries. This includes the benefit structure, the enrolment, ownership issues and other criteria. The second section focuses on the funding of social health insurance by comparing the different approaches to contribution rates and assessment bases, burden of contributions and others. The final section analyses different strategies in the provision and purchasing of health services in the four countries. It is still unclear if competition or regulation is the right means to tackle the widespread problems. Changes involving long-term care and health insurance, supplemental private insurance and the introduction of DRGs are all part of the strategies being undertaken in the study countries. What is clear is that there are certain developments that can be anticipated in the future of social health insurance systems. Foremost among them is the recognition that an integrated approach to health care is imperative for maximizing the quality of care as well as resources. Secondly, new approaches to financing are needed to provide more sustainable health care systems. This book explores some interesting options.