The Politics of Health Care Financing Models - Does the Source of Funding Matter for Health Care Outcome?

Abstract

Does the source of funding matter for the outcome of health care? The aim of this thesis is to analyze to what extent three different health care financing models affect the mortality from cardiovascular diseases. This is done by using OLS with PCSE, followed by two case studies to illustrate the findings. Based on two hypotheses the conclusion is that the National Health Service model and the Social Health Insurance model accounts for lower mortality rates than the Private Health Insurance model. The Social Health Insurance model additionally performs somewhat better than the National Health Service model. The extent of difference is, on the other hand, low, and the systems account for less than 1% of the differences in cardiovascular mortality. The case studies of Poland and Spain did neither present very clear changes in mortality rates affected by the change of financing model, which supports the overall conclusion. At the same time, it is argued that despite the small differences between the models, the extent of explanatory power of the models is high. This is because of the life expectancy in OECD countries is very high, and the postponing of death has a limit. The lack of very clear evidence from the case studies is argued to be due to the slow moving effects of health care, and there is not necessarily reason to expect that a clear decrease in mortality should automatically follow a change of system. There are also great differences in how the models are organized in the different countries, and poor implementation of a system, as arguably has been the case for the social health insurance in Poland, could easily outweigh the general benefits associated with a particular system. Additionally, there seems to be issues regarding model change, and many characteristics from the old systems are often kept within the new. Overall there is a significant correlation between the finance of health care systems and cardiovascular mortality, and given the premise of limited ways of reducing mortality in OECD countries, every improvement should be valued. This thesis therefore lays a solid framework for further discussion of health care policies in high-developed countries.