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Healthcare Reforms Across the World

KIEKE G. H. OKMA * Retraité professeur, Columbia University. Contact :
TIM TENBENSEL ** Professeur, Aukland University.La présente contribution s’inspire largement de l’ouvrage Health Reforms Across the World (Okma et Tenbensel, 2020). Hormis les deux éditeurs, les autres contributeurs à ce livre sont Adam Fusheini (Ghana), Igor Francetic (Tanzanie), Guillermo Paraje (Chili), Santiago Illescas Correa (Équateur), Kieke Okma, Aad de Roo et Hans Maarse (Pays-Bas), Luca Crivelli et Carlo de Pietro (Suisse), Marek Pavlík et Zuzana Kotherová (République Tchèque), Stanka Setnikar Cankar et Dalibor Stanimirovic (Slovénie), David Chinitz (Israël), Toni Ashton et Tim Tenbensel (Nouvelle-Zélande), Kee Sing Chia et Meng-Kin Lim (Singapour) et Tsung-Mei Cheng (Taïwan).

This contribution presents the main findings of an unusual research project of the health reforms of twelve small and mid-sized nations (usually excluded from international comparative studies), that started early 21st century. The 19 co-authors have all lived and worked in one or more of these countries.

Located in different continents, the countries vary in size, population, geography, income level as well as cultural and political backgrounds. Still, they share policy goals to safeguard access to healthcare to their population, improve the population health and protect family income against high costs of medical care – policies long embraced by most industrial nations. They all sought to change some of the core elements of their healthcare systems: the mix of financing sources, the ownership, administration, or payment modes for healthcare services.

Each nation implemented reforms within the restraints of national culture, institutional legacies, and stakeholder positions. That resulted in diverging outcomes, not convergence into one direction or model. What works in one nation, may not work somewhere else.

Our study showed, indeed, a remarkable variety in reform activity, ranging from the partially successful efforts to develop universal coverage in Ghana and Tanzania, the more fragmented insurance schemes of Chile and Ecuador, the new procedure for assessing entitlements of Israel's social insurance, New Zealand's rapid changes in regional healthcare governance combined with a remarkable stable tax-based financing, Taiwan's population-wide health insurance, the quasi-private insurance mandates of Switzerland and The Netherlands and a complex mix of insurance schemes and extensive public subsidy in Singapore.

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