Healthcare systems in Europe: towards an incorporation of patient access

Abstract

The core of existing healthcare typologies is the public—private mix in the three areas of funding, provision and regulation of healthcare services. This article aims to contribute to the debate by adding ‘healthcare access’ as an important dimension for comparing healthcare systems. In contrast to previous analyses, I extend the concept of access by looking at regulative aspects and financial incentives that shape entry and reception of care. Based on empirical indicators for three different dimensions of healthcare access — gatekeeping, cost sharing and supply — a cluster analysis is performed that yields four access regime types: financial incentive states; strong gatekeeping/low supply states; weakly regulated/high supply states; and mixed regulation states. The countries clustered in the access regimes show a different pattern than typologies based on other system indicators. This suggests that previously used dimensions for comparison do not sufficiently capture patients’ access to healthcare.

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