The role of the state in financing and regulating primary care in Europe: a taxonomy
File(s)Espinosa_et_al2021_Health_Policy.pdf (594.68 KB)
Accepted version
Author(s)
Espinosa-González, Ana Belén
Delaney, Brendan C
Marti, Joachim
Darzi, Ara
Type
Journal Article
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.
Date Issued
2021-02
Date Acceptance
2020-11-07
Citation
Health Policy, 2021, 125 (2), pp.168-176
ISSN
0168-8510
Publisher
Elsevier
Start Page
168
End Page
176
Journal / Book Title
Health Policy
Volume
125
Issue
2
Copyright Statement
© 2020 Elsevier B.V. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
National Institute of Health Research
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33358033
PII: S0168-8510(20)30280-3
Subjects
Europe
actors
decentralisation
health systems
primary care
taxonomy
Publication Status
Published
Coverage Spatial
Ireland
Date Publish Online
2020-11-16