Workshop Healthcare systems: change and outcomes. Ideas, institutions, actors, and reforms. 11-12 November 2011, Amsterdam
The Centre for Global Health and Inequality at the University of Amsterdam hosted,
in November 2011, a workshop on Healthcare systems: change and outcomes. Ideas, Institutions, actors, and reforms. The event was organized by Dr Monika Ewa Kaminska, researcher
at the CGHI, in cooperation with Prof. Claus Wendt, the Chair of Sociology of Health and
Healthcare Systems at the University of Siegen. The organization was further supported by
Rosalijn Both, PhD student at the CGHI.
As stated in the Call for Papers, the aim of the workshop was to discuss concepts of
institutional change in health policy, build bridges between different fields, and discuss research on different regions of the world. The organizers received more than forty submissions,
eighteen of which were accepted and included in the programme. Parallel to the workshop’s
sessions, a session for PhD students was organized were further four papers were presented
and discussed by PhD candidate from the Netherlands, Germany and the UK. In total, the
event brought together about 30 researchers studying modalities of change in healthcare systems and focussing both on the macro- and micro-level effects of change.
Cross-cutting themes of the workshop included:
1) The impact of transnational and international processes on healthcare systems change.
Alexandra Kaasch (Collaborative Research Centre 597, Bremen): Help from above, or reflected uncertainty? Transnational ideas about national health systems
Viola Burau/Ellen Kuhlmann*/Pavel Romanov/Elena Iarskaia-Smirnova (*Department of Social and Policy Science, U of Bath): Translating global health policy agendas: comparing
primary care reforms in England, Germany and Russia
Stefan Greß*/Stephanie Heinemann*/Simone Leiber** (*U of Applied Sciences Fulda, **U
of Applied Sciences Düsseldorf): Healthcare system change and the cross-border diffusion of ideas in Germany, Austria, and the Netherlands
2) Hybridization of healthcare systems
Monika-Ewa Kaminska (U of Amsterdam): Back to Bismarck. Or is it? Hybridization of
healthcare systems in ECE
Ralf Götze/Achim Schmid (Collaborative Research Center 597, Bremen): Three is a magic
number – Healthcare funding beyond the public/private dichotomy
3) Role of actors in healthcare systems and their change
Patrick Hassenteufel (U of Versailles): The role and position of doctors in health care system change: A European comparison
Monika-Ewa Kaminska (U of Amsterdam): Back to Bismarck. Or is it? Hybridization of
healthcare systems in ECE
4) New modes of healthcare governance and provision
1
Ståle Opedal*/Hilmar Rommetvedt/Inger Marie Stigen/Karsten Vrangbæk, (*International
Research Institute of Stavanger/IRIS): Health care agreements and consultations – effective instruments for multilevel governance and coordination?
Pauline Allen (London School of Hygiene & Tropical Medicine): Healthcare providers in
the English National Health Service: public, private or hybrids?
Stefano Neri (U of Milan): Public-private partnerships in a decentralized NHS: the case
of Italy.
Kirstein Rummery (School of Applied Social Science, U of Stirling): Healthy partnerships,
healthy citizens? A critical comparative appraisal of health partnerships and user outcomes in the UK
Monika Steffen (U of Grenoble), Reforms and new public management in the French
healthcare system: the challenge of regulating an atypical system
5) Outcomes of health policies and healthcare systems
Hasan Tekgüç/Z. Nurdan Atalay-Güneş (Mardin Artuklu U): Health consequences of an eclectic social security regime: The case of Turkey
Kirstein Rummery (School of Applied Social Science, U of Stirling): Healthy partnerships,
healthy citizens? A critical comparative appraisal of health partnerships and user outcomes in the UK
Liubov V. Borisova*/Terje A. Eikemo** (*Bremen International Graduate School of Social
Science/ **Department of Public Health, University Medical Center Rotterdam): Satisfaction
with health services across European countries
Ganna Gerasymenko (National Academy of Sciences of Ukraine): Estimating the efficiency
of healthcare system in Ukraine: the outcomes for public health
6) Case studies of healthcare policy change
Rudolf Klein (LSE/London School of Tropical Medicine & Hygiene): Competing explanations and interpretative puzzles: the case of the latest NHS reform in England
Julius Cheah (Monash U), The promulgation of neo-liberal policies in the health sector in
Southeast Asia – a case study of Malaysia
Monika Steffen (U of Grenoble), Reforms and new public management in the French
healthcare system: the challenge of regulating an atypical system
Kieke Okma (New York U): Health policy innovation in the Netherlands and Switzerland
Finally, the presentation by Ted Marmor (Yale) and Claus Wendt (U of Siegen): Concepts for analyzing healthcare systems and health reforms was both an excellent summary
of where the current healthcare research stands, and what challenges emerge for future studies
in this field.
2
Based on the research presented during the event, and in particular based on the insights from the contribution by Marmor and Wendt (2011), some challeging lines of inquiry
for the future of the CGHI research programme can be suggested, spanning the fields of
sociology of healthcare, sociology of health and political sociology.
a) Analysis of health policy (programmatic) results, including:
1) Comparative analysis of the results produced or shaped by health policy-making,
governance institutions and constellations of political actors (e.g of costcontainment, priority setting and rationing, coverage/universal access to medical
care, equity and solidarity, patients’ choice) (cf. Wendt and Kohl 2010; Kutzin et
al. 2010).
2) Definition of consistent criteria measuring health policy results in comparative
perspective. (Although this task is difficult as pointed out by Pierson ‘there is
probably no substitute for investigations that pay attention to fairly detailed dimensions of policy change’ in small samples because research on larger samples
‘would require the efforts of a large and well-funded team. So far no one has carried it out’ (Pierson 2001:421)
3) Development of frameworks for assessing the role of health policy actors within
reform process (cf. Hassenteufel et al. 2010 and their work on programmatic actors)
– ‘who presses for particular policies and how those are related to institutional and
economic contexts’
b) Analysis of healthcare systems (organization, financing, provision), including comparative studies comprehensively dealing with the arrangements for financing, delivery and regulation of healthcare systems, with more focus on patients’ access – considering criteria like, for instance, private out-of-pocket payment, gatekeeping, costsharing, provider density, etc. (e.g. Wendt 2009; Reibling 2010)
c) Analysis of healthcare system outcomes (analysis of outcomes related to healthcare
system types) covering for example utilization of healthcare services, people’s perception of healthcare systems, and their health status, health inequalities. In their discussion of the work of Beckfield and Krieger (2009) who review 45 studies on health inequalities published between 1992 and 2008, Marmor and Wendt stress that ‘[o]nly 9
out of 45 studies have concentrated on the effect of the healthcare system itself on
health inequities, and none of the nine studies was comparative’ (Marmor and Wendt
2011). This gap in the current literature could be filled through a cooperation of researchers analysing healthcare systems and researchers studying health – a combination which is definitely possible within the CGHI given the mix of medical anthropologists and sociologists.
3