Reforming Health Care in Seven European Nations

Prologue: Most health care systems the industrialized world over share a number of common characteristics: they insure virtually all of their citizens, they allow patients to select their own physician, and they also constrain medical expenditures at some level that is deemed broadly acceptable to the polity. They also cope with a common reality: they operate in a state of continuous change, striving to adjust to the economic, political, and social demands of the moment. In this essay, Jeremy Hurst provides a glimpse of the nature of change in the 1980s in seven West European nations, all of which have pretty much stabilized the growth of their health care spending to a level that is commensurate with the growth of their national economies. Hurst is a senior economic adviser in the Department of Health, which oversees Britain's National Health Service. He was one of the early pioneers among a small group of economists, health services researchers, and other analysts who have studied the health care systems of the industrialized world. In 1981, he spent a sabbatical year in the United States studying its health care system and that of Canada. In 1989 and 1990, he spent fifteen months at the Organization for Economic Cooperation and Development studying the reform of health care systems for its Working Party on Social Policy. Hurst, like most people who explore this ground, recognizes that the study of health care systems on a comparative basis is in its infancy. Nevertheless, Hurst and others have determined that many industrialized nations have found equitable ways of financing and delivering health care that achieve adequate outcomes (as far as they can be measured). The cost of most of this care is socialized throughout populations, with the rich supporting the poor, the healthy helping the sick, and the young subsidizing the old.