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      Mercantilização nas reformas dos sistemas de saúde alemão, francês e britânico Translated title: Commodification in the reforms of the German, French and British health systems

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          Abstract

          Resumo Desde os anos 1980, os sistemas de saúde europeus vêm passando por várias reformas, com ênfase à tendência de sua mercantilização. O objetivo deste artigo é evidenciar formas de implementação de mecanismos de mercado no funcionamento desses sistemas, alemão, britânico e francês – a partir da década de 1980. As reformas “mercantis” eram justificadas a partir da premissa de que a inserção da lógica de mercado poderia tanto diminuir a necessidade de gastos públicos como aumentar a eficiência dos existentes. O trabalho apresenta diferentes formas de mercantilização implementadas nas reformas, com a distinção entre os processos de mercantilização explícita, em que há efetivo aumento da presença privada, e implícita, em que ocorre a incorporação de princípios advindos do setor privado no sistema público, tanto no financiamento como na prestação de serviços de saúde. Além do detalhamento das diferentes maneiras em que este fenômeno se expressa, o artigo apresenta brevemente os potenciais efeitos negativos desse processo para os sistemas de saúde, principalmente em termos de acesso e equidade, explicitando que as premissas iniciais em torno da mercantilização (redução de gastos e melhora na eficiência) parecem ser falsas.

          Translated abstract

          Abstract Since the 1980s, European health systems have undergone several reforms, with emphasis on the tendency of their commodification. The objective of this article is to demonstrate how market mechanisms were implemented in the functioning of these systems, german, british and french – from the 1980s. The “mercantile” reforms were justified on the premise that the insertion of market logic could both reduce the need for public spending and increase the efficiency of existing expenditure. The work presents different forms of commodification implemented in the reforms, with the distinction between processes of explicit commodification, in which there is an effective increase in private, and implicit presence, in which there is incorporation of principles from the private sector in the public system, both in financing and in the provision of health services. In addition to detailing the different ways in which this phenomenon is expressed, the article briefly presents the potential negative effects of this process for health systems, especially in terms of access and equity, stating that the initial assumptions surrounding commodification (cost reduction and efficiency improvement) appear to be false.

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          Pay for performance in health care: an international overview of initiatives.

          Pay for performance (P4P) has become a popular approach to performance improvement in health care. Most of the P4P literature has focused on the United States and there is limited insight in the characteristics of major programs initiated in other countries. This article systematically describes and reviews P4P programs outside the United States. Our literature search identified 13 programs initiated in 9 countries. Although the programs share many similarities, they differ in several important respects, also when compared with the typical P4P program in the United States. In addition, there are clearly possibilities to increase incentive strength and minimize incentives for undesired behavior. In part, observed heterogeneity will be a consequence of contextual differences, but design choices often also seem to be made arbitrarily. In designing their programs, purchasers are hampered by limited knowledge of the influence of specific design choices and effective strategies to mitigate undesired behavior.
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            The privatization of health care in Europe: an eight-country analysis.

            This article presents an analysis of recent changes in the public-private mix in health care in eight European countries. The leading question is to what extent a process of privatization in health care can be observed. The framework for the analysis of privatization draws on the idea that there are multiple public/private boundaries in health care. The overall picture that emerges from our analysis is diverse, but there is evidence that health care in Europe has become somewhat more private. The growth of the public fraction in health care spending has come to an end since the 1980s, and in a few countries the private fraction even increased substantially. We also found some evidence for a shift from public to private in health care provision. Furthermore, there are signs of privatization in health care management and operations, as well as investments. Specific attention is spent on the identification of factors that push privatization forward and factors that work as a barrier to privatization.
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              How does private finance affect public health care systems? Marshaling the evidence from OECD nations.

              The impact of private finance on publicly funded health care systems depends on how the relationship between public and private finance is structured. This essay first reviews the experience in five nations that exemplify different ways of drawing the public/private boundary to address the particular questions raised by each model. This review is then used to interpret aggregate empirical analyses of the dynamic effects between public and private finance in OECD nations over time. Our findings suggest that while increases in the private share of health spending substitute in part for public finance (and vice versa), this is the result of a complex mix of factors having as much to do with cross-sectoral shifts as with deliberate policy decisions within sectors and that these effects are mediated by the different dynamics of distinctive national models. On balance, we argue that a resort to private finance is more likely to harm than to help publicly financed systems, although the effects will vary depending on the form of private finance.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                2018
                : 23
                : 7
                : 2159-2170
                Affiliations
                [1] São Paulo São Paulo orgnamePontifícia Universidade Católica de São Paulo orgdiv1Departamento de Economia Brazil mariana.jansen@ 123456gmail.com
                [2] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Saúde Pública orgdiv2Departamento de Política, Gestão e Saúde Brazil
                Article
                S1413-81232018000702159
                10.1590/1413-81232018237.12972018
                a6e3df25-21d0-4944-9bff-dbfa3ab12ae5

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 01 June 2018
                : 15 May 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 38, Pages: 12
                Product

                SciELO Brazil


                Mercantilização,Reforma dos sistemas de saúde,Alemanha,França,Reino Unido,Commodification,Health systems reform,Germany,France,United Kingdom

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