Template-type: ReDIF-Article 1.0 Author-Name: Sorenson, Corinna Author-Name: Chalkidou, Kalipso Title: Reflections on the evolution of health technology assessment in Europe Journal: Health Economics, Policy and Law Pages: 25-45 Issue: 1 Volume: 7 Year: 2012 Month: January Abstract: Health technology assessment (HTA) has assumed an increasing role in health systems in recent years, with many countries establishing agencies or programmes to evaluate health technology and other interventions to inform policy decisions and clinical practice. This paper reflects upon its development and evolution in Europe over the last decade, with a focus on England, France, Germany and Sweden. In particular, we explore how HTA has evolved over time as well as its impact on policy and practice. While countries share many of the same objectives, there are differences in the way HTA agencies and programmes are organised, operate, and influence decision making. Despite these differences, all systems are faced with opportunities and challenges related to stakeholder involvement and acceptance, the suitability and transparency of assessment requirements and methods, balancing evidence and values in decision making, and demonstrating impact. File-URL: https://www.cambridge.org/core/product/identifier/S1744133111000296/type/journal_article File-Function: link to article abstract page File-Format: text/html Handle: RePEc:cup:hecopl:v:7:y:2012:i:01:p:25-45_00 Template-type: ReDIF-Article 1.0 Author-Name: Vrangbaek, Karsten Author-Name: Robertson, Ruth Author-Name: Winblad, Ulrika Author-Name: Van de Bovenkamp, Hester Author-Name: Dixon, Anna Title: Choice policies in Northern European health systems Journal: Health Economics, Policy and Law Pages: 47-71 Issue: 1 Volume: 7 Year: 2012 Month: January Abstract: This paper compares the introduction of policies to promote or strengthen patient choice in four Northern European countries – Denmark, England, the Netherlands and Sweden. The paper examines whether there has been convergence in choice policies across Northern Europe. Following Christopher Pollitt's suggestion, the paper distinguishes between rhetorical (discursive) convergence, decision (design) convergence and implementation (operational) convergence (Pollitt, 2002). This leads to the following research question for the article: Is the introduction of policies to strengthen choice in the four countries characterised by discursive, decision and operational convergence? The paper concludes that there seems to be convergence among these four countries in the overall policy rhetoric about the objectives associated with patient choice, embracing both concepts of empowerment (the intrinsic value) and market competition (the instrumental value). It appears that the institutional context and policy concerns such as waiting times have been important in affecting the timing of the introduction of choice policies and implementation, but less so in the design of choice policies. An analysis of the impact of choice policies is beyond the scope of this paper, but it is concluded that further research should investigate how the institutional context and timing of implementation affect differences in how the choice policy works out in practice. File-URL: https://www.cambridge.org/core/product/identifier/S1744133111000302/type/journal_article File-Function: link to article abstract page File-Format: text/html Handle: RePEc:cup:hecopl:v:7:y:2012:i:01:p:47-71_00 Template-type: ReDIF-Article 1.0 Author-Name: O'Reilly, Jacqueline Author-Name: Busse, Reinhard Author-Name: Häkkinen, Unto Author-Name: Or, Zeynep Author-Name: Street, Andrew Author-Name: Wiley, Miriam Title: Paying for hospital care: the experience with implementing activity-based funding in five European countries Journal: Health Economics, Policy and Law Pages: 73-101 Issue: 1 Volume: 7 Year: 2012 Month: January Abstract: Following the US experience, activity-based funding has become the most common mechanism for reimbursing hospitals in Europe. Focusing on five European countries (England, Finland, France, Germany and Ireland), this paper reviews the motivation for introducing activity-based funding, together with the empirical evidence available to assess the impact of implementation. Despite differences in the prevailing approaches to reimbursement, the five countries shared several common objectives, albeit with different emphasis, in moving to activity-based funding during the 1990s and 2000s. These include increasing efficiency, improving quality of care and enhancing transparency. There is substantial cross-country variation in how activity-based funding has been implemented and developed. In Finland and Ireland, for instance, activity-based funding is principally used to determine hospital budgets, whereas the models adopted in the other three countries are more similar to the US approach. Assessing the impact of activity-based funding is complicated by a shortage of rigorous empirical evaluations. What evidence is currently available, though, suggests that the introduction of activity-based funding has been associated with an increase in activity, a decline in length of stay and/or a reduction in the rate of growth in hospital expenditure in most of the countries under consideration. File-URL: https://www.cambridge.org/core/product/identifier/S1744133111000314/type/journal_article File-Function: link to article abstract page File-Format: text/html Handle: RePEc:cup:hecopl:v:7:y:2012:i:01:p:73-101_00 Template-type: ReDIF-Article 1.0 Author-Name: Helderman, Jan-Kees Author-Name: Bevan, Gwyn Author-Name: France, George Title: The rise of the regulatory state in health care: a comparative analysis of the Netherlands, England and Italy Journal: Health Economics, Policy and Law Pages: 103-124 Issue: 1 Volume: 7 Year: 2012 Month: January Abstract: In a relatively short time, regulation has become a significant and distinct feature of how modern states wish to govern and steer their economy and society. Whereas the former ‘dirigiste’ state used to be closely related to public ownership (e.g. hospitals), planning (volume and capacity planning) and centralised administration (e.g. fixed prices and budgets), the new regulatory state relies mainly on the instrument of regulation to achieve its objectives. In this paper, we wish to relate the rise of the ‘regulatory state’ to the path-dependent trajectories and institutional legacies of discrete European health-care systems. For this purpose, we compared the Dutch corporatist social health insurance system, the strongly centralised National Health Service (NHS) of England and federal regionalised NHS system of Italy. Comparing these three different health-care systems suggests that it is indeed possible to identify a general trend towards the rise of the regulatory state in health care in the last two decades. However, although the three countries examined in this paper face similar problems of multilevel governance of networks of third-party payers and providers, each system also gives rise to its own distinct regulatory challenges. File-URL: https://www.cambridge.org/core/product/identifier/S1744133111000326/type/journal_article File-Function: link to article abstract page File-Format: text/html Handle: RePEc:cup:hecopl:v:7:y:2012:i:01:p:103-124_00 Template-type: ReDIF-Article 1.0 Author-Name: Nolte, Ellen Author-Name: Knai, Cécile Author-Name: Hofmarcher, Maria Author-Name: Conklin, Annalijn Author-Name: Erler, Antje Author-Name: Elissen, Arianne Author-Name: Flamm, Maria Author-Name: Fullerton, Brigit Author-Name: Sönnichsen, Andreas Author-Name: Vrijhoef, Hubertus J. M. Title: Overcoming fragmentation in health care: chronic care in Austria, Germany and the Netherlands Journal: Health Economics, Policy and Law Pages: 125-146 Issue: 1 Volume: 7 Year: 2012 Month: January Abstract: The growing recognition of care fragmentation is causing many countries to explore new approaches to healthcare delivery that can bridge the boundaries between professions, providers and institutions and so better support the rising number of people with chronic health problems. This paper examines the role of the regulatory, funding and organisational context for the development and implementation of approaches to chronic care, using examples from Austria, Germany and the Netherlands. We find that the three countries have implemented a range of policies and approaches to achieve better coordination within and across the primary and secondary care interface and so better meet the needs of patients with chronic conditions. This has involved changes to the regulatory framework to support more coordinated approaches to care (Austria, Germany), coupled with financial incentives (Austria, Germany) or changes in payment systems (the Netherlands). What is common to the three countries is the comparative ‘novelty’ of policies and approaches aimed at fostering coordinated care; however, the evidence of their impact remains unclear. File-URL: https://www.cambridge.org/core/product/identifier/S1744133111000338/type/journal_article File-Function: link to article abstract page File-Format: text/html Handle: RePEc:cup:hecopl:v:7:y:2012:i:01:p:125-146_00