Fixing Health Budgets: Experience from Europe and North America

The notion of a fixed health budget seems self-evident: a public or private payer sets a time-tied ceiling on expenditures. Such a definition, while correct, is nonetheless far from sufficient. In actual practice, the key issues revolve around not only the ?what?, but also the ?who? and the ?how? of establishing and maintaining periodic health care expenditure ceilings. The design and implementation of fixed budgets in health systems?not to mention their success?varies considerably between countries, within countries, and between health sub-sectors. Fixing Health Budgets: Experience from Europe and North America reviews the impact of financial reform on the quality and delivery of health care in Austria, Canada, Germany, the Netherlands, Sweden, the UK and the USA. It outlines how far countries have moved to adopt fixed budgets and how management on a macro-, meso- and micro-level of the various systems is coping with the challenges and conflicts between the providers, patients, community and society. Its message has relevance for health care providers, public policy analysts and health economists worldwide, as well as providers of health education and social services.