ISBN: 0-8247-8829-X Thisbookisprinted onacid-freepaper. Headquarters MarcelDekker,Inc. 270MadisonAvenue,New York,NY 10016 tel:212-696-9000;fax:212-685-4540 EasternHemisphereDistribution MarcelDekkerAG Hutgasse4,Postfach812,CH-4001Basel, Switzerland tel:41-61-261-8482;fax: 41-61-261-8896 World WideWeb http://www.dekker.com The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the headquarters address above. Copyright2002 byMarcelDekker,Inc. AllRights Reserved. Neitherthisbook norany partmay bereproducedortransmittedinany formorbyany means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from thepublisher. Currentprinting (lastdigit): 10 9 8 7 6 5 4 3 2 1 PRINTEDINTHEUNITEDSTATESOFAMERICA Preface Thisbookprojectwasinitiatedatatimewhenrisingexpendituresforhealthcare were of great concern and a precipitating factor in calls for health care reform in the United States. Many other developed countries that had experienced in- creases in health care expenditures also viewed these events with increasing alarm. The concern over rising costs has prompted governments to examine the underlying factors and to take action. The role of government in health care usuallyincorporatestwomajordimensions:thefinancingofhealthcareandother socialprograms,andthedetermination,tosomeextent,ofhowthedeliverysys- tem is organized. Thus, government action occurs most often in the form of re- structuringthehealthcaresystemoralteringthemechanismsforfinancinghealth care.Howextensivethisroleisvarieswiththehistoryandcultureofeachnation, whichinfluencethephilosophyandvaluesconcerningtheappropriateparameters for government involvement in the affairs of its citizens. Thegovernment’sabilitytofinanceservicesislimitedbyitsabilitytoraise fundingthroughtaxationandthentomanageandallocatethesefundseffectively andefficiently.Indevelopedcountries,taxpayersattempttodeterminetheirwill- ingnesstobetaxedthroughtheirvotingbehaviorsforpoliticalpartiesandcandi- dateswithwhosepromisedpositionsontaxationandgovernmentspendingthey agree.Voterswhofavorgovernmentspendingonparticularprogramsareusually willingtobetaxedfortheprovisionofthoseprograms.Voterswhoareconcerned with containing government spending are less likely to be willing to pay taxes, let alone tax increases. Asexpendituresforhealthcarehavesteadilyrisen,votersandgovernments have had to become more aware of the tradeoffs between spending for health care andspending forother desiredprograms,as wellastheimpactofreducing spending on health care. While the extent of government involvement in the iii iv Preface financingandorganizationofhealthcare doesvaryamongcountries,thesecon- cerns over steadily rising costs are common. Theintentof thisbook istoexaminewhatvarious countrieshavedonein the area of health care financing, what the role of the national government has been, how the health care system is financed, how the providers are organized and structured, and whether these activities have been successful in addressing rising costs and expenditures. The book is intended to provide policy makers, researchers, and students of health care policy and administration with valuable information about various health care systems. This book is dedicated to the memory of Dr. Sharon M. McManus, co- editorofthebook.Dr.McManuswasascholarandanadvocateforherstudents. Shewillbemissedbyallwhocameincontactwithher.Determinedtocomplete this bookin the memory ofDr. McManus, Iinvited a dear colleague, Dr. Terry Wimberley, to fill the void left by Dr. McManus. Without his participation, the book would not havebeen finished by this time. I appreciate hishard work and his willingness to join this book project. Ialsoappreciatethepatience,understanding,andcooperationofallcontrib- utors of this book, particularly those who completed their chapters very early and had to spend time to revise and update their early drafts. Special thanks go to Dr. Jack Rabin, editor of the Public Administration and Public Policy series, and Marcel Dekker, for accepting the original proposal and offering valuable encouragement. I am especially grateful for the professional assis- tance ofMs.PaigeForce,ProductionEditor,andotherstaffmembersatMarcel Dekker, Inc. Khi V. Thai Contents Preface iii Contributors vii 1. Introduction to International Health Care Systems: Themes and Variations on Themes 1 Edward T. Wimberley and Khi V. Thai 2. Reforms in the Hungarian Health Care System 29 Tama´s Evetovits 3. Russia’s Health Care System: Caring in a Turbulent Environment 59 Elena A. Bourhanskaia, Aren Kubataev, and Mary A. Paterson 4. The Canadian Health Care System 79 Kant Patel and Mark E. Rushefsky 5. The United States Health Care System 99 Carole M. Pohl 6. Like Plugging the Holes in a Colander: Health Policy and Provision in the United States Circa the Millennium 135 Edward T. Wimberley and Arthur J. Rubens v vi Contents 7. The Health Services System in Mexico 207 World Health Organization 8. France’s Health Care System 235 Peter L. Cruise 9. Universal Coverage and Cost Control: The United Kingdom National Health Service 261 Karen Bloor and Alan Maynard 10. Sweden’s Health Care System 287 Paul Gunnar Kaati 11. The German Health Care System 333 Balu Swami 12. Italy’s Health Care System 359 Michelle A. Angeletti 13. The Political Economy of Health Care in Greece 395 Dimitris Niakas 14. Health Care System in Turkey 431 Fahreddin Tatar and Tevfik Dinc¸er 15. The Japanese Health Care System: Citizen Complaints and Citizen Possibilities 457 Rieko Yajima and Kazue Takayanagi 16. The Health Care System in Australia 487 Helen M. Lapsley 17. A Health Care System in Radical Transition: The Experience of New Zealand 505 Laurence Malcolm 18. Health Care Financing: A Comparative Analysis 543 Khi V. Thai, Sharon M. McManus, and Edward T. Wimberley Index 573 Contributors MichelleA.Angeletti InterimChairandAssistantProfessor,DepartmentofIn- terdisciplinaryStudies,CollegeofHealthProfessions,FloridaGulfCoastUniver- sity, Fort Myers, Florida Karen Bloor Department of Health Sciences and Clinical Evaluation, Univer- sity of York, Heslington, York, England Elena A. Bourhanskaia Office of Health Care Policy Research and Develop- ment, University of Nevada, Las Vegas, Nevada Peter L. Cruise Assistant Professor, Health and Community Services Depart- ment, California State University, Chico, California Tevfik Dinc¸er Professor, School of Health Administration, Hacettepe Univer- sity, Ankara, Turkey Tama´s Evetovits Health Services Management Training Center, Semmelweis University, Budapest, Hungary PaulGunnarKaati Professor,CommunityMedicineandRehabilitation,Social Medicine, University of Umea, Umea, Sweden ArenKubataev OfficeofHealthCarePolicyResearchandDevelopment,Uni- versity of Nevada, Las Vegas, Nevada Helen M. Lapsley Economist, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia vii viii Contributors Laurence Malcolm Professor Emeritus and Consultant, Aotearoa Health, Lyttelton, New Zealand AlanMaynard DepartmentofHealthEconomics,UniversityofYork,Hesling- ton, York, England Sharon M. McManus† Associate Professor and Chair, Division of Health Sci- ences, Macon State College, Macon, Georgia Dimitris Niakas Associate Professor, Health Services Management, School of Social Sciences, Hellenic Open University, Patras, Greece Kant Patel Professor, Department of Political Science, Southwest Missouri State University, Springfield, Missouri Mary A. Paterson Office of Health Care Policy Research and Development, University of Nevada, Las Vegas, Nevada Carole M. Pohl Associate Professor, Health Administration Program—Indus- try Studies, Florida Atlantic University, Boca Raton, Florida ArthurJ.Rubens AssociateProfessor,DepartmentofManagement,andDirec- tor, Sponsored Projects and Programs, Center for Leadership and Innovation, Florida Gulf Coast University, Fort Myers, Florida MarkE.Rushefsky Professor,DepartmentofPoliticalScience,SouthwestMis- souri State University, Springfield, Missouri Balu Swami Business Analyst, Risk Management (IT), AT&T Wireless Ser- vices, Inc., Bothell, Washington KazueTakayanagi AssociateProfessor,DepartmentofHealthServicesAdmin- istration, Nippon Medical School, Tokyo, Japan Fahreddin Tatar* Associate Professor, School of Health Administration, Ha- cettepe University, Ankara, Turkey Khi V. Thai Professor, School of Public Administration, Florida Atlantic Uni- versity, Fort Lauderdale, Florida †Deceased *Currentaffiliation:TheFuturesGroupInternational/POLICYProject,Ankara,Turkey Contributors ix Edward T. Wimberley AssociateProfessor,Divisionof InterdisciplinaryStud- ies, College of Arts and Sciences, Florida Gulf Coast University, Fort Myers, Florida RiekoYajima ResearchFellow,DepartmentofHealthServicesAdministration, Nippon Medical School, Tokyo, Japan