A bstract . The French health care delivery system is characterized, on the one hand, by a centralized and socialized decision making process as far as financing is concerned, yet on the other hand, the regulation of activities is highly decentralized and governed mainly by individual physicians on a private basis. Today, the health care scene seems to be stuck in a process within which each new reform leads to yet another reform, In this movement, the role played by academic health economists is increasing. The French health care delivery system and its dynamics are described and two major topics which wilt be at stake in the years to come, the remuneration of physicians and the financing of hospitals are considered. The challenge facing health economists who have to consider the system as a system, is examined. The relationships between the political arena and the researcher's ivory tower appears to be is one of the keys for the future of the health care system. It is demonstrated that, in this area too, few barriers have fallen.
Abstract Equity and solidarity are key issues in the current political debate concerning the Swiss health care system and possible reforms to it. Equal access to medical care has always been a basic principle which has been strongly supported by all political parties and is reflected in the legal framework. Because the health care system is highly decentralized, assigning most of the responsibilities to the 26 cantons, these legal statements exist predominantly on the cantonal level. For example, the communities are compelled by cantonal law to guarantee access to those who need it but cannot afford it (Undritz 1987, p. 21). However, no such consensus exists with respect to health care financing. The conservative parties favour financing schemes which promote efficiency but are regressive (such as a high share of private financing, high co-insurance rates, and deductibles). By contrast, the parties with a strong social committment support financing schemes which are progressive (high share of tax-financing, low co-insurance rates, and deductibles, free care). In the 1980s, the actual development was characterized by a decreasing share of tax-financing and increased co-insurance rates, thus increasing the regressiveness of the financing system. However, this development is likely to be reversed in the near future. A referendum is pending, proposing a massive increase in the share of tax-financed health care, and seems to have a good chance of winning the vote. These developments should be kept in mind when interpreting our empirical findings which related to the situation in 1982.
Selecting a Communication Service Organization : the Ministry of Finance Determining what type of organization to select is a very central question for a communication service and the success of its activities. Based on an initial assessment, what communication strategy should be adopted, which type of organization should be selected, how can central and decentralized structures be connected ?
The present article is a critical account of the official report from the Commission of Inquiry on Health and Social Services in Quebec (la Commission Rochon). This report is first examined in light of the socio-political context of Quebec society in the '80s with a particular emphasis on factors which directly influenced the development of the Commission's work. The author then presents the main elements of the report. He stresses the quality and appropriateness of studies bearing on Quebec social evolution during the last 20 years and on the identification of health and social problems in the present time. He reminds us of the radical diagnosis made on the organization of health services. The principal options for more adequate health system orientations are then studied in the context of debates following the report publication, two years ago, particularly concerning issues of regional decentralization and financing. The author finally stresses the new challenges of today in social health management, while showing the profound continuity existing between the Commission's works and those of the Castonguay Commission, at the beginning of the '70s.