Financing universal access to healthcare a comparative review of landmark legislative health reforms in the OECD

Financing Universal
Access to Healthcare
A Comparative Review of
Landmark Legislative Health
Reforms in the OECD

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World Scientific Series in Health Investment and Financing
ISSN: 2591-7315
Series Editor: Alexander S. Preker (Columbia University, USA and

Health Investment & Financing Corp, USA)
Most western developed countries offer universal access to healthcare through mechanisms
that provide financial protection against its high cost, either through insurance or government subsidy programs.
In most middle- and low-income countries, financing is often at the center of reforms in the
healthcare sector. Success or failure of these reforms can have major impact on the political
survival of governments that get involved, and major implications for the dynamics of the
healthcare industry and overall economy.
With this series, World Scientific will contribute knowledge about a policy area which
is still poorly-understood. The series merges policy and practice, exploring the economic
underpinnings of real trends in health investment and financing.
The series will appeal and be accessible to investors, the health insurance industry, healthcare actuaries, business schools with healthcare tracts, healthcare management programs,
researchers, graduate students, policy makers and practitioners working in the health sector
worldwide.
Vol. 1

Financing Universal Access to Healthcare:
A Comparative Review of Landmark Legislative Health Reforms in the OECD
by Alexander S. Preker

Forthcoming
Financing Universal Access to Healthcare: A Comparative Review of Incremental Health
Insurance Reforms in the OECD

Alexander S. Preker
Financing Micro Health Insurance: Theory, Methods and Evidence

David M. Dror
Role of Private Financing in the Education of Health Workers:
Gaining the Competitive Edge

Alexander S. Preker, Hortenzia Beciu and Eric Keuffel
Capital Finance in the Health Industry: A User Manual for Investors and Companies

Alexander S. Preker and Les Funtleyder
Handbook on Health System Financing and Organization

Dov Chernichovsky

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World Scientific Series in Health Investment and Financing – Vol. 1

Financing Universal
Access to Healthcare
A Comparative Review of
Landmark Legislative Health
Reforms in the OECD

Alexander S. Preker
Columbia University, USA
Health Investment & Financing Corporation, USA

World Scientific
NEW JERSEY

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Published by
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Library of Congress Cataloging-in-Publication Data
Names: Preker, Alexander S., 1951– author.

Title: Financing universal access to healthcare : a comparative review of landmark legislative health
reforms in the OECD / by Alexander S Preker (Columbia University, USA).
Other titles: World Scientific series in health investment and financing ; v. 1.
Description: New Jersey : World Scientific, 2018. | Series: World Scientific series in
health investment and financing ; volume 1 | Includes bibliographical references.
Identifiers: LCCN 2017035131 | ISBN 9789813227163 (hc : alk. paper)
Subjects: | MESH: Organisation for Economic Co-operation and Development. | Health Services
Accessibility--economics | Healthcare Financing | Universal Coverage--legislation &
jurisprudence | Health Care Reform--legislation & jurisprudence | Health Expenditures
Classification: LCC RA971.3 | NLM W 76.1 | DDC 362.1068/1--dc23
LC record available at />British Library Cataloguing-in-Publication Data
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DEDICATION

This volume is dedicated to all those who will continue the struggle of
achieving “Health for All” so that the dream of a world with “Universal
Health Care Coverage” will be achieved in the twenty-first century. The
“giants among giants” of the past, like the late Professor Brian AbleSmith, have passed the baton for this agenda to the next generations of
leaders.

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FOREWORD
This year, as we commemorate the 40th Anniversary of the Alma-Ata
Declaration of “Health for All” on October 25–26 in Almaty, Kazakhstan, as
well as the 70th Anniversary of the UK National Health Service, we also
celebrate the great achievements in bringing affordable access to quality
health services for billions of people across the world over the past decades.
This book provides a seminal review of the political process, the economic underpinnings and implementation challenges involved in achieving
Universal Health Coverage (UHC). The creation of the UK National
Health Service out of the ashes of the bombs dropped on London during
the Second World War was a stark reminder of the important role that hospitals and emergency services played in complementing primary care
under UHC. Although this volume focusses on OECD countries that provide access to comprehensive health service based on clinical need, available to all — not on the ability to pay — through major legislative reforms,
other European countries like Germany, France, Switzerland and the
Netherlands achieved similar coverage through a more gradual incremental
legislative process. How these latter countries also achieved UHC for their
populations and similar stories in low- and middle-income countries will
be the focus of a forthcoming volume by Professor Alexander S. Preker.
During his 25 year career at the World Bank and International Finance
Corporation, the author was an influential voice on UHC in the Bank, the
International Labor Organization, and the World Health Organization. His
international work during these past three decades emphasized the need to
underpin worthy aspirations and declarations with needed funding, human
vii

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viii

Foreword

resources and implementation capacity at the country level. As a member of
the World Bank team which wrote the World Development Report 1993 on
“Investing in Health” and the WHO team which wrote the World Health
Report 2000 on “Health Systems: Improving Performance”, and throughout
his career, the author has emphasized that good health is part of economic
development and that “investing in health” is a worthy economic goal, not
just a lofty social aspiration. The comparative health systems framework
and country case studies reviewed in this volume reflect this philosophy.
During this period, it was an honor to have had a chance to work with
Professor Preker and to have benefited from his insights on and innovative
approaches to health care financing and service delivery.
The International Hospital Federation (IHF) is committed to advancing the UHC agenda throughout the world, giving billions of people better
access to critical hospital care and basic health services when needed,
irrespective of their income or geographic location in the world. Since its
establishment in 1929, the IHF recognizes the essential role of hospitals
and health care organizations in providing health care, supporting health
services and offering education to health care providers as a critical partner during the drive for UHC throughout the world.
This pragmatic philosophy underpins the Almaty Declaration 2.0,
which will reflect the changing expectations of health care providers, the
needs of patients, and the challenges posed by the Sustainable Development
Goals 2030. I am optimistic that the renewed approach to both primary
and more advanced health care will respond to the health needs and aspirations of people throughout the world through better access and more
effective use of all available health services and their associated technologies. The conditions are now present to move to a real health systems

approach in which all players from front-line workers to higher levels of
the referral system in both the public and private sectors can contribute
effectively to all the dimensions of the UHC agenda.
This volume is a tribute to this renewed effort in achieving “Health for
All”.
Eric de Roodenbeke
Executive Director
International Hospital Federation
Geneva

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b2932   A Comparative Review of Landmark Legislative Health Reforms in the OECD

PREFACE

Financing Health for All. What is the most practicable system of
charging people for health care ….
… Thirteen years after the Health-for-All programme [Alma Ata
1978] was launched, the availability of the necessary finance remains a
formidable obstacle to future progress in many developing countries.
The hope that governments would increase spending on health care to
5% of the national income is in most cases unlikely to realize. Nor is
there evidence that donors are willing to increase their aid to developing
countries or to divert more of it to the health sector. Ministries of health

are being left to find their own solution. Is the way forward to be found
in user charges, community financing, private insurance, or some system
of formal compulsory insurance? How does one decide which are the
more promising options for a particular country? What has been learned
from the experience of countries which have tried to go down particular
roads?
Brian Able-Smith (1991)
“Financing Health-for-All”
World Health Forum, Vol 12

The public sector of all western developed countries has become increasingly involved in financing health care during the past century. Today, 13
OECD countries have passed landmark legislative reforms that call for
compulsory prepayment and universal entitlement to comprehensive services, while most of the others achieve similar coverage through a mixture
of public and private voluntary arrangements. This study carried out a
ix

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Preface

detailed analysis of why, how and to what effect governments became
involved in health care financing in eight of these countries.

During the early phase of this evolution, reliance on direct out-ofpocket payment and an unregulated market mechanism for the financing,
production and delivery of health care led to many unsatisfactory outcomes in the allocation of scarce resources, redistribution of the financial
burden of illness and stabilization of health care activities. This forced the
state to intervene through regulations, subsidies and direct provision of
services. Expansion in prepayment of health care gradually occurred
through private insurance, social insurance and general revenues in
response to different socio-economic, political and bureaucratic forces.
Although improving health may have been the ultimate goal, offering
universal access to affordable health care was the way the countries examined achieved this objective.
Universal comprehensive coverage was associated with a decade of
stable public expenditure on health care compared with GDP, total government expenditure and government consumption expenditure. There
were no disproportionate increases in health care expenditure or displacement of public funds away from social programs that depended on cash
transfer payments. Nor do the countries that offer such social protection
have higher public debt or poorer economic performance compared with
the rest of the OECD. Measures of health status are unfortunately still not
sufficiently developed or standardized to permit a detailed analysis of this
aspect of outcome through cross-national comparisons. Furthermore, the
countries examined may be more vulnerable to political backlash because
of the high visibility of their government involvement in health care
financing.

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ABOUT THE AUTHOR

Professor Alexander S. Preker is a globally
recognized expert on the economics of investing and financing health systems, health care
policy, governance and health care reform. He
has been an advisor to Ministers of Health and
senior policy makers throughout the world on
capital investment in the health sector, health
financing, health insurance, public–private
partnerships and the political process of health
care reform. And he is on the executive board
of several private health care companies.
Professor Preker is a Commissioner with the Global Commission on
Pollution, Health and Development. He is an Honorary Member of the
International Hospital Federation, a Member of the Board of the USA
Health Care Alliance and several other organizations that deal with health
policy and health reform.
Professor Preker is an Adjunct Associate Professor for Health Care
Management at the Mailman School of Public Health at Columbia
University in New York. He is an Adjunct Associate Professor of Public
Policy at New York University’s Robert F. Wagner Graduate School of
Public Policy and he is an Executive Scholar at the Icahn School of
Medicine at Mount Sinai in New York.
In addition to his health policy and academic work, Professor Preker is
also active in the private health sector. He is President and CEO of Health
xi

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xii

About the Author

Investment & Financing Corporation, a New York based firm that specializes
in investment and advisory services for small and medium size health care
businesses. He is one of the founding members of the New York Chapter of
the Keiretsu Forum, a crowd funding platform with over US$800 million in
investments, and a LLP with Keiretsu Capital, a US$10 million early stage
investment fund. He is an active investor in the OurCrowd Health and Life
Sciences Portfolio and Landmark Angels and he manages the New York Due
Diligence Fellowship program for the Keiretsu Forum at Columbia University.
Prior to his current work, Professor Preker had a distinguished career,
working at different times for International Bank of Reconstruction and
Development (IBRD), International Development Association (IDA),
International Finance Corporation (IFC) and World Health Organization
(WHO).
From 2007 to 2012, he was head of the Health Industry Group and
Investment Policy for the International Finance Corporation (IFC). In this
position, he and his team set up a US$1 billion investment facility for health
to support expansion of small and medium size business in the Africa. Prior to
his work at the IFC, Professor Preker was the Chief Economist for the health
sector in the World Bank Group at a time that the annual lending pipeline was
about US$3 billion and a total portfolio value in the range of US$15 billion.
While at the World Bank career, Professor Preker worked with both
Lawrence Summers (former Director of the National Economic Council

under the Obama Administration) and Joseph Stiglitz (recipient of the
Nobel Memorial Prize in Economic Sciences) during their respective tenures as Chief Economist for the World Bank Group as well as many
Ministers of Health, Finance Economic Development and other senior
officials in the client countries he served.
Professor Preker is a prolific writer and has published extensively,
having authored and co-authored over 20 books, many scientific articles
and has been the primary author of a wide range of institutional reports
and policy briefs. While at the World Bank, he was a member of the
Editorial Board for the World Bank’s External Operations Publication
Department and Editor in Chief of its health care publications.
Professor Preker’s training includes a Ph.D. in Economics from the
London School of Economics and Political Science, a Fellowship in Medicine
from University College London, a Diploma in Medical Law and Ethics from
King’s College London, and a M.D from University of British Columbia.

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ACKNOWLEDGMENTS

Guidance and wisdom from late Professor Brian Abel-Smith, London
School of Economics and Political Science, provided the main inspiration
for looking in detail at the political economy of health care reforms leading to successful implementation of universal access to affordable health
coverage. Special recognition is given to Professor Rudolf Klein,

University of Bath, whose constructive comments led to a critical revision
of the original draft manuscript and more rigorous comparative and social
policy analysis.
Countless others contributed insights over the years on the application
of the original work to developing countries and elaboration of a comprehensive analytical framework for cross-country comparative studies and
performance evaluation in health care policy and financing reforms.
Notably Professors Dov Chernichovsky (Ben Gurion University),
André-Pierre Contandriopoulos (University of Montreal), Alain Enthoven
(Stanford), Robert Evans (University of British Columbia), Mark V.
Pauly (Wharton School, University of Pennsylvania), Uwe Reinhardt
(Princeton), Richard M. Scheffler (Berkeley), Joseph E. Stiglitz (Columbia
University), Wynand P.M.M. van de Ven (Erasmus University), and Peter
Zweifel (University of Zurich) provided the intellectual underpinnings
for exploring the economics of private and public approaches to health
insurance.
Over the past 30 years, deep insights were gained on the topic of universal health coverage from the global and country level collaboration
among the World Bank Group, the International Labour Organization
xiii

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Acknowledgments

(ILO), and the World Health Organization (WHO). Notable bilateral players committed to improving health financing include the Australian Agency
for International Development (AusAid), the British Department for
International Development (DFID), Canadian International Development
Agency (CIDA), the Danish International Development Agency (DANIDA),
the Dutch Government, the French Agence Française de Développe­ment
(AFD), the German Deutsche Gesellschaft für Internationale Zusammenar­
beit (GIZ), the Japanese International Cooperation Agency (JICA), the
Norwegian Agency for Development Cooperation (NORAD), the Swedish
International Development Cooperation Association (SIDA), and the US
Agency for International Development (USAID).
The International Federation of Health Plans (iFHP), countless other
bilateral, non-governmental and academic organizations, and national
governments carrying out health financing reforms contributed valuable
insights.
Appreciation is expressed for the collaboration and deeper understanding on the approaches to universal health care gained insights over
the years from: Olusoji O. Adeyi, Chris Atim, Ladi Awosika, Cristian
Baeza, Enis Baris, Nicholas Barr, Mark C. Bassett, Hortenzia Beciu,
Paolo Belli, Peter A. Berman, Ricardo Bitrán, Reinhard Busse, Guy
Carrin, Mukesh Chawla, Michael Cichon, Jorge A. Coarasa, Catherine
Connor, Rafael Cortez, Daniel Cotlear, Agnes Couffinhal, Diana Dennett,
François Diop, Richard G.D. Feachem, David M. Dror, Yohana Dukhan,
Bjorn O. Ekman, Guy Ellena, Maria Louisa Escobar, David B. Evans,
Scott D. Featherston, David de Ferranti, Julio Frenk, Hernán L. FuenzalidaPuelma, Jacques van der Gaag, Sherry Glied, Pablo Gottret, Ian GrantWhyte, Charles C. Griffin, Ralph Harbison, April Harding, Loraine
Hawkins, Richard Hinz, Peter S. Heller, Jürgen Hohmann, William C.
Hsiao, Melitta Jakab, Dean Jamison, Vijayasekar Kalavakonda, Daniel
Kress, Gerald M. La Forgia, Gina Lagomarsino, John C. Langenbrunner,
Rodney Lester, Maureen Lewis, Marianne E. Lindner, James Christopher
Lovelace, Caroline Ly, Hans Maarse, Marty Makinen, Theodore R.
Marmor, Anne Mills, Henry Mintzberg, Philip Musgrove, Somil Nagpal,

Stefan Nachuk, Allyala Nandakumar, Charles Normand, Kieke Okma,
Nathaniel Otoo, Mead Over, Ariel Pablos-Mendez, Ok Pannenborg, Oscar
Picazo, Jean-Pierre Poullier, Khama Rogo, Eric de Roodenbeke, Aaltje de

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Acknowledgmentsxv

Roos, Jeffrey Sachs, Thomas Sackville, Xenia Scheil-Adlung, Onno P.
Schellekens, George Schieber, Agnes Soucat, Michael S. Sparer, Nicole
Tapay, Robert Taylor, Edit V. Velenyi, Adam Wagstaff, Hong Wang,
Marie-Odile Waty, Alan Williams and Ke Xu.
Appreciation is expressed to Herbert Moses, Shreya Gopi, Anthony
Alexander, Nisha Rahul and Ranjana Rajan at World Scientific for their
diligence during the editorial process in preparing the manuscript and to
Kathleen A. Lynch, independent consultant and developmental editor, and
to members of the World Bank publication department for the editorial
support provided over the years. I am also very grateful to my family,
friends, and feline companions for their unconditional love, support and
wise counsel.

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CONTENTS

Forewordvii
Prefaceix
About the Authorxi
Acknowledgmentsxiii
List of Figures and Tablesxxix
Part I  Introduction

1

Chapter 1 Analytical Framework

3




4
8

A. Historical Role of the State
B. Determinants of Public Policy

1. Level of Socio-economic Development
2. Political Processes

9
11

(a)Ideology
(b)Democratization
(c) Political Party Formation

12
14
15

3. Bureaucratic Structures
4. Market Failure

18

20





26
27
32

C.Normative Functions of Modern Governments
D.Measuring Performance of Health Care Reforms
E. Policy Processes

1.Convergence
2.Diffusion

32
33
xvii

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Contents

3.Interdependence
4.Evolution
Endnotes

34
34
36

Chapter 2  Methodology65






A. Hybrid Discipline
B. Scientific Method
C.Objectives
D.Hypotheses
E. Research Design

65
66
68
70
73

1.Styles
2.Elements

74
78

(a) Dimensions (Contextual)
(b) Countries (Spatial)
(c) Time Period (Temporal)

79
82
87



F. Data Collection

89

1.Descriptive
2.Quantitative

90
91



95

G. Analytical Techniques

1.Descriptive

96

(a) Positivist Analysis
(b) Linguistic Analysis

97
98

2.Quantitative

100

(a) Time Series
(b) Cross-sectional Analysis

101
105

Endnotes

109

Part II National Profiles

123

Chapter 3  New Zealand

125



125

A. Historical Context

1. Colonial Military Outposts
2. National Insurance Plan of 1882
3. Friendly Societies

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125
126
128

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Contentsxix

B. Landmark Legislative Reforms

129

1. General Election of 1935
2. International Communist and Socialist Influence
3. National Health Insurance Committee of 1935
4. Parliamentary Investigation Committee of 1937
5.Select Committee on National Health and
Superannuation of 1937
6. Social Security Act of 1938
7. Social Security Amendment Bill of 1941

136
138
139



140

C. Continued Policy Reform Process

129
132
133
134

1. Hostages to History
2. From the 1950s to the 1980s
3. Major Policy Updates in New Zealand Since the 1980s

140
141
142

Endnotes

144

Chapter 4  United Kingdom

151



151

A. Historical Context

1.
2.
3.
4.


Elizabethan Poor Laws

Lloyd George’s National Insurance Plan of 1911
World War I to the Great Depression
World War II

B. Landmark Legislative Reforms

151
154
155
157
158

1. Beveridge’s Report
2. Vested-Interest Groups
3. Brown’s Plan
4. White Paper
5. Willink’s Plan
6. Bevan’s Plan
7. National Health Service Act of 1946

158
160
161
163
165
166
167

171

C. Continued Policy Reform Process

1. Administrative Reorganizations
2. UK Entry into the European Union
3.Major Policy Updates in the United Kingdom
Since the 1980s
Endnotes

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171
172
172
174

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Contents

Chapter 5Canada185

A. Historical Context

1.
2.
3.
4.
5.
6.


B. Landmark Legislative Reforms

1.
2.
3.
4.


The British North America Act of 1867
Provincial Government Health Programs
Heagerty Committee Draft Bill of 1944
Dominion-Provincial Conference of 1945
National Hospital and Diagnostic Services Act of 1957
Provincial Health Insurance
Royal Commission on Health Services
Federal-Provincial Conference of 1965
National Medicare Program
Strike, Armed Insurrection and War Measures

C. Continued Policy Reform Process

1. Canada Health Act of 1984
2. Major Policy Reforms in Canada Since the 1980s
Endnotes

185
185
186
188
190
191
194
196
196
199
200
203
205
205
206
208

Chapter 6Australia219


A. Historical Context

1.
2.
3.

4.
5.
6.


B. Landmark Legislative Reforms

1.
2.
3.
4.


Colonial Government Health Services
Doctors and Pre-paid Health Care
Royal Commission on National Insurance of 1923
National Health and Pensions Insurance Act of 1938
National Health Services Act of 1948
Earle Page Voluntary Insurance of 1953
Committee of Inquiry into Health Insurance of 1968
Scotton–Deeble Compulsory Insurance Plan of 1969
Whitlam Labor Government of 1972
Medibank I

C. Continued Policy Reform Process

1. Earle Page Revisited
2. Medicare of 1984

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219
219
222
223
224
226
228
230
230
231
232
234
239
239
241

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Contentsxxi

3. Major Policy Reforms in Australia Since the 1980s
Endnotes

242
243

Chapter 7Denmark255


A. Historical Context

1.
2.
3.
4.
5.
6.
7.


B. Landmark Legislative Reforms

1.
2.
3.
4.
5.
6.
7.


Early Danish Sickness Funds

Law on Recognized Sickness Funds of 1892
Danish Medical Association
Minor Social Reform of 1921
Social Insurance Law of 1933
World War II
Public Sickness Insurance Law of 1960
Danish Social Politics
County Councils and Municipalities
Parliamentary Resolution of 1964
Social Reform Commission of 1969
Sickness Funds’ Publicity Campaign
Social Reform Investigations
Sickness Insurance Law of 1971

C. Continued Policy Reform Process

1. Entry into the European Union
2. Groennegår Committee of 1986
3. Major Policy Updates in Denmark Since the 1980s
Endnotes

255
255
256
258
259
260
261
262
263

263
265
266
267
269
270
272
273
273
274
275
276

Chapter 8Norway285


A. Historical Context

1.
2.
3.
4.
5.
6.

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Sickness Funds
County Medical Officer
Committee Work

The Labour Party
Compulsory Sickness Insurance Law of 1909
Norwegian Medical Association

285
285
287
287
288
290
291

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B. Landmark Legislative Reforms

1.
2.
3.
4.
5.
6.

Contents

The Great Depression
War Occupation and Joint Reconstruction Program
Parliamentary Decree
Social Insurance Committee Report No. I
Social Insurance Committee Report No. II
Compulsory Universal Sickness Insurance Law of 1956

C. Continued Policy Reform Process

1. Civil Defense Health Plan
2. Health for All
3. Decision to Remain Outside the European Union
4. Major Policy Updates in Norway Since the 1980s
Endnotes

292
292
294
295
298
299
301
303
303
305
306

307
308

Chapter 9  Sweden319


A. Historical Context

319

1. Swedish Sickness Funds
2. Social Democratic Party

319
323



325

B. Landmark Legislative Reforms

1.
2.
3.
4.
5.


Social Security Commission of 1938

Sickness Insurance Law of 1947
Höjer Report of 1948
Swedish Medical Association
Sickness Insurance Law of 1953

C. Continued Policy Reform Process

1.
2.
3.
4.
5.
6.

Regional Hospital Plan of 1958
Swedish Younger Doctors’ Association
Seven Crowns Reform of 1969
Public Health Service Act of 1981
Entry into the European Union
Major Policy Updates in Sweden Since the 1980s

Endnotes

325
327
328
330
330
332
332

334
335
338
339
339
341

Chapter 10  Finland351


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A. Historical Context

351

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Contentsxxiii

1.
2.
3.

4.
5.


B. Landmark Legislative Reforms

1.
2.
3.
4.


Early Health Provisions
Finnish Medical Association
Public Involvement
Multi-party Politics
First Parliamentary Proposal
Governmental Proposal to Parliament of 1954
Sickness Insurance Committees
Social and Political Transformation
Sickness Insurance Act of 1963

C. Continued Policy Reform Process

351
352
353
354
355
356

356
357
359
362
365

1. Beyond Social Insurance
2. Public Health Act of 1972
3. Finnish “Health for All” of the 1970s
4. Entry into the European Union
5. Major Policy Updates in Finland Since the 1980s
Endnotes

365
367
371
372
372
374

Part III Discussion

383

Chapter 11  Analysis385


A. Clarification of Concepts

385

1. Financing Mechanisms
2.Participation
3.Entitlement

387
392
394



396

B.Hypotheses (Why, How and To What Effect)

1. Determinants of Health Policy (Why)

396

(a) Socio-economic Development
(b) Political Processes

(i)  Ideology

(ii)  Democratization
(iii)  Political Party Formation and Vested Interests
(c) Bureaucratic Structures
(d) Market Failure

397

399
400
404
407
412
417

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Contents

2. Normative Functions of Governments (How and What)

422

(a) Allocation Function
(b) Distribution Function
(c) Stabilization Function

422
427
432

3.Outcome from Public Financing of Health Care
(To What Effect)
Endnotes

436
442

Chapter 12  Performance Evaluation

461




461
462

A. Performance Evaluation Log-frame 
B. Country Performance

1. New Zealand

462

(a)Inputs
(b)Process
(c)Outputs
(d) Proxy Measures
(e) Impact Indicators

462
463
465
465
466


(i)  Financial Protection

(ii)  Health Outcomes
(iii)  Patient Experience

466
466
467

2. United Kingdom

469

(a)Inputs
(b)Process
(c)Outputs
(d) Proxy Measures
(e) Impact Indicators

469
470
471

472
472


(i)  Financial Protection

(ii)  Health Outcomes
(iii)  Patient Experience

472
473
474

3.Canada

475

(a)Inputs
(b)Process
(c)Outputs
(d) Proxy Measures

475
477
478
478

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