Health systems often require tweaking, fine-tuning, and even reconstruction.
Healthcare legislation in countries in transition, emerging economies, and developing countries should permit – and use economic incentives to encourage – a structural reform of the sector, including its partial privatization.
· Universal healthcare vs. selective provision, coverage, and delivery (for instance, means-tested, or demographically-adjusted)
· Health Insurance Fund: Internal, streamlined market vs. external market competition
· Centralized system – or devolved? The role of local government in healthcare.
· Ministry of Health: Stewardship or Micromanagement?
· Customer (Patient) as Stakeholder
· Imbalances: overstaffing (MDs), understaffing (nurses), geographical distribution (rural vs. urban), service type (overuse of secondary and tertiary healthcare vs. primary healthcare)
· To amend existing laws and introduce new legislation to allow for changes to take place.
· To effect a transition from individualized medicine to population medicine, with an emphasis on the overall welfare and needs of the community
Hopefully, the new legal environment will:
· Foster entrepreneurship;
· Alter patterns of purchasing, provision, and contracting;
· Introduce constructive competition into the marketplace;
· Prevent market failures;
· Transform healthcare from an under-financed and under-invested public good into a thriving sector with (more) satisfied customers and (more) profitable providers.
· Transition to Patient-centred care: respect for patients’ values, preferences, and expressed needs in regard to coordination and integration of care, information, communication and education, physical comfort, emotional support and alleviation of fear and anxiety, involvement of family and friends, transition and continuity.
The Law and regulatory framework should explicitly allow for the following:
I. PURCHASING and PURCHASERS Natural Insert
(I1) Private health insurance plans (Germany, CzechRepublic, Netherlands), including franchises of overseas insurance plans, subject to rigorous procedures of inspection and to satisfying financial and governance requirements. Insured/beneficiaries will have the right to apply contributions to chosen purchaser and to switch insurers annually.
Private healthcare plans can be established by large firms; guilds (chambers of commerce and other professional or sectoral associations); and regions (see the subchapter on devolution under VI. Stewardship).
Private insurers: must provide universal coverage; offer similar care packages; apply the same rate of premium, unrelated to the risk of the subscriber; cannot turn applicants down; must adhere to national-level rules about packages and co-payments; compete on equality and efficiency standards.
(I11) Breakup of statutory Health Insurance Fund to 2-3 competing insurance plans (possibly on a regional basis, as is the case in France) on equal footing with private entrants.
Regional funds will be responsible for purchasing health services (including from hospitals) and making payments to providers. They will be not-for-profit organizations with their own boards and managerial autonomy.