|This article focuses on two major questions concerning the changing role of the state in the health care systems of OECD countries. Firstly, we ask whether major changes in the level of state involvement (in health care systems) have occurred in the past thirty years. Given the fact that three types of health care systems – which are characterized by a distinct role of the state – evolved during the golden age, we secondly discuss how this distinctiveness – or more technically: variance – has changed in the period under scrutiny. While many authors analysing health policy changes exclusively concentrate on finance and expenditure data, we simultaneously consider financing, service provi-sion, and regulation.
As far as financing is concerned, we observe a small shift from the public to the pri-vate sphere with a tendency towards convergence in this dimension. Expanding Peter Flora’s “growth to limits” theses, due to the ongoing increase of total financing and the melting off of the public share “private growth and public limits” might be a future trend in the financing dimension of health care systems. The few data available on ser-vice provision, in contrast, show neither signs of retreat of the state nor of convergence. In the regulation dimension – which we analyse by picking major health system reforms in Germany, the United Kingdom and the United States – we see the introduction or strengthening of those co-ordination mechanisms (hierarchy, markets and self-regulation) which were traditionally weak in the respective type of health care system. “Gate-keeping” and DRG models are remarkable examples to show that health policy might increasingly be oriented at “best practices” even when the respective solutions are beyond the traditional path of reforms. Putting these findings together we find a ten-dency of convergence from distinct types towards mixed types of health care systems.
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