• What are the characteristics that define a social health insurance system?
• How is success measured in SHI systems?
• How are SHI systems developing in response to external pressures?

Using the seven social health insurance countries in western Europe – Austria, Belgium, France, Germany, Luxembourg, the Netherlands and Switzerland – as well as Israel, this important book reviews core structural and organizational dimensions, as well as recent reforms and innovations.

Covering a wide range of policy issues, the book:

• Explores the pressures these health systems confront to be more efficient, more effective, and more responsive
• Reviews their success in addressing these pressures
• Examines the implications of change on the structure of SHIs as they are currently defined
• Draws out policy lessons about past experience and likely future developments in social health insurance systems in a manner useful to policymakers in Europe and elsewhere

Social health insurance systems in western Europe will be of interest to students of health policy and management as well as health managers and policy makers.

Visit Social health insurance systems in western Europe Download Page

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Edited by Richard B. Saltman, Reinhard Busse & Josep Figueras
European Observatory on Health Systems and Policies series
Published by Open University Press
2004, 328 pages
ISBN 0 335 21363 4 (Paperback) £24.99
ISBN 0 335 21364 2 (Hardback) £70.00

INTRODUCTION
The concept of social health insurance (SHI) is deeply ingrained in the fabric of health care systems in western Europe. It provides the organizing principle and a preponderance of the funding in seven countries – Austria, Belgium, France, Germany, Luxembourg, the Netherlands and Switzerland.

Since 1995, it has also become the legal basis for organizing health services in Israel. Previously, SHI models played an important role in a number of other countries that subsequently changed to predominantly tax-funded arrangements in the second half of the twentieth century – Denmark (1973), Italy (1978), Portugal (1979), Greece (1983) and Spain (1986). Moreover, there are segments of SHI-based health care funding arrangements still operating in predominantly tax-funded countries like Finland, Sweden and the United Kingdom, as well as in Greece and Portugal.

In addition, a substantial number of central and eastern European (CEE) countries have introduced adapted SHI models since they regained control over national policy-making – among them Hungary (1989), Lithuania (1991), Czech Republic (1992), Estonia (1992), Latvia (1994), Slovakia (1994) and Poland (1999). ...

FORWARD
Countries that rely upon social health insurance (SHI) for the preponderant portion of their health system funding present many paradoxes. SHI systems are constructed upon privately owned and operated funding arrangements, yet these arrangements – and the bodies that administer them – are tightly confined by statutory requirements. They are based on institutions rooted in civil society, yet most important decisions are subject to review by the state.

They call themselves SHI systems, yet some rely for up to 50 per cent of total funding upon public taxes and/or out-of-pocket payments. They announce the centrality of solidarity in their operation, yet not all citizens are covered by these SHI institutions. They are highly popular with their citizenry, yet they require higher funding levels and larger total payments than do their predominantly tax-funded counterparts. ...

THE EDITORS
Richard B. Saltman is Professor of Health Policy and Management at the Rollins School of Public Health, Emory University in Atlanta, USA and Research Director of the European Observatory on Health Systems and Policies.

Reinhard Busse is Professor and Department Head of Health Care Management at the Technische Universität in Berlin, Germany and Associate Research Director of the European Observatory on Health Systems and Policies.

Josep Figueras is Head of the Secretariat and Research Director of the European Observatory on Health Systems and Policies and Head of the European Centre for Health Policy, Brussels, WHO Regional Office for Europe.

THE CONTRIBUTORS
Helmut Brand, Jan Bultman, Reinhard Busse, Laurent Chambaud, David Chinitz, Diana M.J. Delnoij, André P. den Exter, Aad A. de Roo, Anna Dixon, Isabelle Durand-Zaleski, Hans F.W. Dubois, Josep Figueras, Bernhard Gibis, Stefan Greß, Bernhard J. Güntert, Jean Hermesse, Maria M. Hofmarcher, Martin McKee, Pedro W. Koch-Wulkan, Claude Le Pen, Kieke G.H. Okma, Martin Pfaff, Richard B. Saltman, Wendy G.M. van der Kraan, Jürgen Wasem, Manfred Wildner, Matthias Wismar.

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