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Free to Choose: A Personal Statement

AANGEPAST DOOR ANNE:[-]Dit boek geeft een uitgebreid overzicht van alle sociale hervormingen die de afgelopen dertig jaar in Europa zijn doorgevoerd. Aan bod komen Duitsland, Oostenrijk, Frankrijk, Belgi , Nederland, Spanje, Itali , Zwitserland, Tsjechi , Hongarije, Polen en Slowakije. Bruno Palier toont aan dat al deze landen vergaande hervormingen hebben doorgevoerd in hun zorgstelsel. De oudere structuren, gebaseerd op de eerste sociale zorgstelsels als die onder Bismarck, voldoen niet meer aan de hedendaagse maatschappelijke behoeften. Zo is met de emancipatie van werknemers de hi rarchische structuur veranderd en is de man niet langer vanzelfsprekend de kostwinner van het gezin. Tegenwoordig hebben veel landen een duaal systeem dat onderscheid maakt tussen bescherming van goedfunctionerende burgers en de ondersteuning en motivatie van 'atypische' deelnemers aan de samenleving.[-][-]Bruno Palier is onderzoeker aan de Fondation nationale des sciences politiques in Parijs en wetenschappelijk co rdinator van de European Network of Excellence, Reconciling Work and Welfare in Europe (RECWOWE).[-][-][-]During the 2000s, all continental European countries implemented important structural reforms of their welfare systems (a shift to multi-pillar pension systems, activation, competition in health insurance and care policies outside the family). Even though the changes only became fully apparent over the past decade, this book shows that they must be understood as the culmination of a longer reform trajectory. This book is devoted to the detailed analysis of this reform trajectory. Taken together, the reforms have contributed to a reorganisation of the Bismarckian welfare systems as a whole: they have lost their encompassing capacities, partly turned to activation and employment-friendliness, and weakened the strongest elements of their male breadwinner bias. Instead of the emergence of new hybrid welfare systems, the book concludes that Continental Europe witnessed the development of dual welfare systems that differentiate between the protection of the core workers and the activation of the -atypical (low skilled) ones, and thus contribute to the dualisation of Continental European societies.

/pdf/a-long-goodbye-to-bismarck-the-politics-of-welfare-reform-in-36zn7yk8o6.pdf

A Long Goodbye to Bismarck? : The Politics of Welfare Reform in Continental Europe

Book Review: Transforming Disability into Ability. Policies to Promote Work and Income Security for Disabled People

본 과제는 노동부 국제협상팀에서 제112차 경제협력개발기구(OECD) 고용노동사회위원회(ILSAC) 정례회의 참석을 요청해 옴에 따라 회의의 주요 의제 자료인 ‘Sickness, Disability and Work : Breaking the Barriers, Vol. 2 호주, 룩셈부르크, 스페인, 영국’의 국가사례들을 요약 정리한 것이다. OECD의 분석에 따르면 최근 노동시장의 재구조화가 이루어지면서 핵심 일자리가 축소되고 노동 불안정성이 증가되는 부정적인 변화가 일어나고 있다고 한다. 이러한 변화는 ‘틈새직종(niche jobs)’의 상실과 엄격해진 근로조건, 근로 압력으로 인한 건강손상과 스트레스 증가, 병으로 인한 결근 휴직(sickness absence)의 증가 등의 2가지 경로를 통해 장애인구에 영향을 미친다고 한다.. 이러한 문제는 노동시장의 문제를 의료적인 관점으로 환원하는 ‘medicalization of labor market problems’라는 새로운 현상을 야기시키고 있다. 즉 평균적인 건강 상태는 더욱 향상되고 있다고 보고되나 왜 더 많은 생산가능 인구들이 노동시장을 떠나 건강과 관련한 소득 보장에 의존하는가하는 문제에 직면시키고 있다 하는데, 이에 대해 호주, 룩셈부르크, 스페인, 영국의 장애보상체계와 고용정책을 면밀히 분석하여 비교 분석함으로써 시사점을 제시하고 있다. 결국 병으로 인한 결근, 휴직(sickness absence)의 증가나 장애보상수급은 장애인들의 객관적 혹은 주관적 건강지표와 무관하며, 오히려 국가의 장애정책과 경제적 사회현상에 좌우되는 사안이라고 주장하고 있다. 이와 관련하여 한국의 장애보상체계에 대한 검토와 향후 장애연금 도입 전망에 대한 의견을 제시하였다.

[OECD 2007 장애정책 리뷰] Sickness, Disability and Work : Breaking the Barriers

See also News p 1542 

Long term care is a reality for thousands of frail older people, a source of great anxiety for many more and, across the developed world, a political hot potato that shows no sign of cooling. The heat is fuelled by two factors. Firstly, current government policy in many countries is widely perceived to be unjust, with older people themselves paying an ever greater proportion of the costs of health care. Secondly, the rising percentage of older people in the population, while fuelling doom laden economic projections, is inexorably increasing the power of the older vote, producing democratic pressure for change that is gradually intensifying. This week's changes to the funding of long term care in Scotland will further intensify this pressure (p 1542).

Very shortly after winning power in May 1997, the New Labour government in the United Kingdom sought to deal with the problem by appointing a royal commission to examine the options and to recommend how the costs of care should be apportioned between public funds and individuals.1 In June 2000, after delaying a decision for more than a year, the government refused to implement the commission's most important …

Long term care for older people.

This paper reviews the literature on reference pricing (RP) in pharmaceutical markets. The RP strategy for cost containment of expenditure on drugs is analyzed as part of the procurement mechanism. We review the existing literature and the state-of-the-art regarding RP by focusing on its economic effects. In particular, we consider: (1) the institutional context and problem-related factors which appear to underline the need to implement an RP strategy, i.e., its nature, characteristics and the sort of health care problems commonly addressed; (2) how RP operates in practice, that is, how third party-payers (the insurers/buyers) have established the RP systems existing on the international scene (i.e., information methods, monitoring procedures and legislative provisions); (3) the range of effects resulting from particular RP strategies (including effects on choice of appropriate pharmaceuticals, insurer savings, total drug expenditures, prices of referenced and non-referenced products and dynamic efficiency; (4) the market failures which an RP policy is supposed to address and the main advantages and drawbacks which emerge from an analysis of its effects.

https://papers.ssrn.com/sol3/Delivery.cfm/99040607.pdf?abstractid=159230&mirid=5

Review of the Literature on Reference Pricing

Vejez, dependencia y cuidados de larga duración: situación actual y perspectivas de futuro

The consolidation of a universal health system coupled with a process of regional devolution characterise the institutional reforms of the National Health System (NHS) in Spain in the last two decades. However, scarce empirical evidence has been reported on the effects of both changes in health inputs, outputs and outcomes, both at the country and at the regional level. This paper examines the empirical evidence on regional diversity, efficiency and inequality of these changes in the Spanish NHS using cross-correlation, panel data and expenditure decomposition analysis. Results suggest that besides significant heterogeneity, once we take into account region-specific needs there is evidence of efficiency improvements whilst inequalities in inputs and outcomes, although more 'visible', do not appear to have increased in the last decade. Therefore, the devolution process in the Spanish Health System offers an interesting case for the experimentation of health reforms related to regional diversity but compatible with the nature of a public NHS, with no sizeable regional inequalities.

/pdf/diversity-and-regional-inequalities-assessing-the-outcomes-3xwbniz4zp.pdf

Diversity and Regional Inequalities: Assessing the Outcomes of the Spanish 'System of Health Care Services'

The deadly effects of losing health insurance

espanolLa evolucion de la prestacion sanitaria media parece moverse a impulsos de dos grandes factores: los tecnologicos, en gran medida exogenos a las autoridades sanitarias, y los politicos, o endogenos en respuesta a las expectativas y preferencias sociales sobre las posibilidades de la medicina en las sociedades occidentales. Como resultado, las capacidades de tratamiento sanitario se expanden, de la mano de la presion ciudadana, en sociedades cada vez mas medicalizadas y en las que la industria sanitaria tiene un gran peso mediatico. En Espana, el incremento de la prestacion sanitaria media registrada en los ultimos anos aparece como coetanea a la descentralizacion sanitaria. Asi, existe diversidad no solo en razon del contenido de algunas prestaciones sanitarias, sino tambien de su utilizacion por parte de la poblacion. Nos interrogaremos en este trabajo acerca de la influencia de la descentralizacion sanitaria como inductor del crecimiento del gasto sanitario. A dicho fenomeno se asociaran aspectos relativos aprocesos de "ilusion financiera", o de emulacion de politicas con falta de corresponsabilizacion en el gasto por parte de sus gestores. La tesis que deseamos mantener es que la "devolucion" de responsabilidades fiscales a las comunidades autonomas puede ser un buen antidoto para el control del gasto sanitario y, en particular, de los diferenciales de utilizacion. Con el nuevo sistema de financiacion autonomica, la integracion de la financiacion sanitaria en la general permite introducir los mecanismos necesarios para el autocontrol del gasto que aseguren una efectiva sostenibilidad de la financiacion de la sanidad publica en el proximo futuro. EnglishTechnological and social factors are beyond the increasing share of health expenditure on GDP. This implies that a mix of exogenous and endogenous factors influence health care delivery. Professional aims and social expectations on the production possibility frontier of health, on cure and care treatments, make for a rather difficult control of public health expenditure in OECD countries if reforms are not undertaken in the near future. In Spain, the rise in public health expenditure seems to go hand by hand, with an important decentralization power of health care delivery to Regional Authorities. Whether this is just a coetaneous or a relevant explanatory factor is examined in this paper.The lack of fiscal accountability and some "fiscal ilusion" aspects may undoubtedly influence, overall, public expenditure. But the absence of a rational distribution formula of regional health expenditure at he national level is an important factor too. The argument of the paper focusses on the need of "devolution" of full responsabilities on health expenditure to the Spanish Autonomous Communities. A "fiscal room" process is proposed as a result of some technical adjustments on a capitative finance basis. Cross-boundary flows of patients, age structure of the population, teaching and research "externalities"

Guillem López i Casasnovas

Papers

Review of the Literature on Reference Pricing

Vejez, dependencia y cuidados de larga duración: situación actual y perspectivas de futuro

Diversity and Regional Inequalities: Assessing the Outcomes of the Spanish 'System of Health Care Services'

The deadly effects of losing health insurance

Financiación autonómica y gasto sanitario público en España