The role of the state in financing and regulating primary care in Europe: a taxonomy.

Details

Serval ID
serval:BIB_D7C3D1CE0D65
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The role of the state in financing and regulating primary care in Europe: a taxonomy.
Journal
Health policy
Author(s)
Espinosa-González A.B., Delaney B.C., Marti J., Darzi A.
ISSN
1872-6054 (Electronic)
ISSN-L
0168-8510
Publication state
Published
Issued date
02/2021
Peer-reviewed
Oui
Volume
125
Number
2
Pages
168-176
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Traditional health systems typologies were based on health system financing type, such as the well-known OECD typology. However, the number of dimensions captured in classifications increased to reflect health systems complexity. This study aims to develop a taxonomy of primary care (PC) systems based on the actors involved (state, societal and private) and mechanisms used in governance, financing and regulation, which conceptually represents the degree of decentralisation of functions. We use nonlinear canonical correlations analysis and agglomerative hierarchical clustering on data obtained from the European Observatory on Health Systems and Policy and informants from 24 WHO European Region countries. We obtain four clusters: 1) Bosnia Herzegovina, Czech Republic, Germany, Slovakia and Switzerland: corporatist and/or fragmented PC system, with state involvement in PC supply regulation, without gatekeeping; 2) Greece, Ireland, Israel, Malta, Sweden, and Ukraine: public and (re)centralised PC financing and regulation with private involvement, without gatekeeping; 3) Finland, Norway, Spain and United Kingdom: public financing and devolved regulation and organisation of PC, with gatekeeping; and 4) Bulgaria, Croatia, France, North Macedonia, Poland, Romania, Serbia, Slovenia and Turkey: public and deconcentrated with professional involvement in supply regulation, and gatekeeping. This taxonomy can serve as a framework for performance comparisons and a means to analyse the effect that different actors and levels of devolution or fragmentation of PC delivery may have in health outcomes.
Keywords
Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Europe, Finland, France, Germany, Greece, Humans, Ireland, Israel, Malta, Norway, Poland, Primary Health Care, Republic of North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, United Kingdom, actors, decentralisation, health systems, primary care, taxonomy
Pubmed
Web of science
Create date
11/01/2021 11:36
Last modification date
05/01/2022 6:36
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