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Integration vs separation in the provision of health care: 24 OECD countries compared

Published online by Cambridge University Press:  11 December 2018

Federico Toth Open the ORCID record for Federico Toth [Opens in a new window]
Federico Toth*
Affiliation:
University of Bologna
*
*Correspondence to: Federico Toth, Dipartimento di Scienze Politiche e Sociali, Strada Maggiore, 45, Bologna40125, Italy. Email: federico.toth@unibo.it
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Abstract

This article proposes a classification of the different national health care systems based on the way the network of health care providers is organised. To this end, we present two rivalling models: on the one hand, the integrated model and, on the other, the separated model. These two models are defined based on five dimensions: (1) integration of insurer and provider; (2) integration of primary and secondary care; (3) presence of gatekeeping mechanisms; (4) patient's freedom of choice; and (5) solo or group practice of general practitioners. Each of these dimensions is applied to the health care systems of 24 OECD countries. If we combine the five dimensions, we can arrange the 24 national cases along a continuum that has the integrated model and the separated model at the two opposite poles. Portugal, Spain, New Zealand, the UK, Denmark, Ireland and Israel are to be considered highly integrated, while Italy, Norway, Australia, Greece and Sweden have moderately integrated provision systems. At the opposite end, Austria, Belgium, France, Germany, the Republic of Korea, Japan, Switzerland and Turkey have highly separated provision systems. Canada, The Netherlands and the United States can be categorised as moderately separated.

Keywords

classificationintegrationhealth care provisionintegrated careOECD
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 2 , April 2020 , pp. 160 - 172
Copyright
© Cambridge University Press 2018

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