2005 Seminar 1: Choosing country Health Politics Ana Rico, Associate Professor Department of Health Management and Health Economics

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2005 Seminar 1: Choosing country Health Politics Ana Rico, Associate Professor Department of Health Management and Health Economics

2005 CONFIGURATIONSCOUNTRIESSuccess NHIFailure NHS 5 factors +: SUELC 4 factors +: SuELC SUeLC SUElC Sweden, Norway Austria Denmark, Finland Luxemburg factors +: sUELc SUeLc SUElc SUelC SueLC United Kingdom, New Zealand Iceland France Japan Belgium, Germany, Netherlands factors +: SUelc sUElc SuELc sueLC Italy Ireland Australia, Canada Switzerland? factors +: suelC suelc Switzerland? USA DETERMINANTS OF NHI REFORM: QCA measurement DETERMINANTS OF NHI REFORM: QCA measurement S upportive culture U nitary E xecutive dominance L eft rule C orporatism

In the most generous WS, all 5 causes present: NOR, SWE 2. Given a supportive culture, a left party, and a corporatist pattern of IGs intermediation, NHI enacted even if unfavourable political institutions AUS, DEN, FIN, BEL, GER, NETH 3. Unitary states with supportive cultures, enacted NHI even if rest of conditions unfavourable ICE, FRA, ITA, JAP 4. Anglosaxon countries with a dominant executive and left parties enacted NHI in spite of rest of factors unfavourable UK, IRE, CAN, AUSL, NZ 5. Causes of American excepcionalism: “The USA [is] the only country with unfavourable conditions in all 5 vars.” DETERMINANTS OF NHI REFORM: Analysis DETERMINANTS OF NHI REFORM: Analysis MAIN CONCLUSION: “ To date, the absence of favourable [(political) institutions] has only been overcome by the simoultaneous presence of all three other supportive factors (culture, labour party, corporatism)”

2005 THE US EXCEPTION IN HEALTH & WELFARE 1930s: Succesful pro-poor WS (cash transfers) reform BUT failed health care reform  1. Success WS + 2. failure HC Europe: pro-poor WS + HC 1960s-1970s: Succesful pension reform, limited unemployment reform, and very limited (pro-poor & aged) health care reform  Partial success WS + limited success HC Europe: s : Failed universal health care reform  Failure HC Europe: s (But Switerland 1999) 1970s-2000s. Further expansion of coverage/programmes Some retrenchment & re-structuring EVIDENCE: 2. NORTH AMERICA

2005 Source: McKee, 2003

2005 PER CAPITA PUBLIC EXPENDITURE 1995 % SATISFIED WITH HC SYSTEM, 1996 CANADA US

2005

% CITIZENS SATISFIED WITH THE HEALTH CARE SYSTEM Source: Eurobarometers. Data provided by H Dubois (European Observatory, EOHSP) and A Dixon (LSE, EOHSP). On the US: Blendon R Kim M Benson J (2001) The public vs. WHO on health system performance, Health Affairs, 20, 3: Canada 1998 US 1998

2005

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