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Health Care Systems in Transition

III

Contents

Foreword............................................................................................. v

Acknowledgements .......................................................................... vii

Introduction and historical background .......................................... 1

Introductory overview .................................................................... 1

Historical background .................................................................... 4

Organizational structure and management ..................................... 7

Organizational structure of the health care system ......................... 7

Planning, regulation and management ............................................ 9

Decentralization of the health care system ................................... 13

Health care finance and expenditure ............................................. 17

Main system of finance and coverage .......................................... 17

Health care benefits and rationing ................................................ 19

Sources of finance ........................................................................ 20

Health care expenditure ................................................................ 25

Health care delivery system ............................................................ 31

Public health services ................................................................... 31

Primary health care ....................................................................... 35

Ambulatory secondary care .......................................................... 38

Inpatient care ................................................................................ 39

Social care .................................................................................... 45

Human resources and training ...................................................... 47

Pharmaceuticals ............................................................................ 53

Health technology assessment ...................................................... 56

Financial resource allocation .......................................................... 59

Third-party budget setting and resource allocation ...................... 59

Payment of hospitals .................................................................... 61

Payment of physicians .................................................................. 63

Health care reforms ......................................................................... 65

Aims and objectives ..................................................................... 65

Reforms and legislation ................................................................ 69

Reform implementation ................................................................ 70

Conclusions ....................................................................................... 75

Bibliography ................................................................................... 77

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