Strategies in the Healthcare Sector in France, Germany, Japan, and the Netherlands: A Comparative Study

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Henke, Klaus-Dirk; Schreyögg, Jonas

Working Paper

Towards sustainable health care systems: Strategies
in health insurance schemes in France, Germany,
Japan and the Netherlands ; a comparative study
Diskussionspapiere // Technische Universität Berlin, Fakultät Wirtschaft und Management, No. 2004/9
Provided in Cooperation with:
Technische Universität Berlin, School of Economics and Management

Suggested Citation: Henke, Klaus-Dirk; Schreyögg, Jonas (2004) : Towards sustainable health care systems: Strategies in health insurance schemes in France, Germany, Japan and the Netherlands ; a comparative study, Diskussionspapiere // Technische Universität Berlin, Fakultät Wirtschaft und Management, No. 2004/9, http://hdl.handle.net/10419/36410

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Towards sustainable health care systems
Strategies in health insurance schemes in France, Germany, Japan and the Netherlands
– A comparative study –
23. March 2004

Klaus-Dirk Henke, Jonas Schreyögg1

Berlin, March 2004

1

Berlin Technical University, Faculty of Economics and Management, Department for Public Finance and Health Economics and Department for Health Care Management, E-mail: k.henke@finance.ww.tu-berlin.de; jonas.schreyoegg@tu-berlin.de,The authors would like to thank Mr. Tom Stargardt for excellent research assistance.

Abstract
In all four countries health care expenditures grow while the revenue remains at the same level or even shrinks in many cases. Due to medical progress, ageing and many other factors the gap is widening over time. The pay-as-you-go approach is running against limits either with rising employer and employee contribution rates as is the case in the so-called BismarckSystems or with higher taxes in the so-called Beveridge-systems. There are differences regarding the solutions of each country to tackle the described challenge and they might be able to learn from each other if they are compared. Therefore the study compares the health care systems of France, Germany, Japan and the Netherlands. Due to the complexity of the different institutional settings it seems necessary to select certain criteria in order to make a comparison at all possible. The comparison is divided into three different sections. The institutional and organizational framework as first section compares the general organization of social health insurance in all four countries. It comprises the benefit structure, the enrolment, ownership issues and other criteria. The second section focuses on the funding of social health insurance comparing the different approaches according to criteria like contribution rates, contribution 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. Next to other hospital ownership infrastructure...
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