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  • DEMERITT David (3)
  • ROTHSTEIN Henry (3)
  • PAUL Regine (2)
  • BENDJABALLAH Selma (2)
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  • Article (8)
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in Les tribunes de la santé Publication date 2020-10
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Dix ans après son passage, toujours relativement intacte malgré les nombreuses tentatives républicaines d’abrogation totale ou partielle, l’Obamacare a permis de ralentir la croissance des dépenses de santé et d’améliorer significativement l’accès aux soins de la population. Elle a permis à près de 20 millions de personnes qui en étaient privées auparavant d’obtenir une assurance santé. Trente millions de personnes restent néanmoins non assurées, loin des promesses d’une couverture médicale « quasi » universelle entendues dans les discours démocrates en 2010. Quelques mois avant les élections présentielles de novembre 2020 et en pleine pandémie de Covid-19, ces limites appellent à réformer la réforme. Cet article revient sur les avancées et sur les limites de l’Obamacare dix ans après son vote, ainsi que sur les inflexions menées sous les républicains.

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What could a European Union (EU) response mechanism to health emergencies look like in the context of a more integrated Health Union? Despite an increased EU role in the preparedness, monitoring and coordination of health emergencies over the past two decades, Member States’ responses to the first wave of COVID-19 were surprisingly uncoordinated. In light of calls to improve cooperation regarding future health emergencies, this article discusses the creation of EU surveillance, preparedness and response mechanisms for health emergencies. Using insights from previous research and secondary literature, we highlight gaps in the existing serious cross-border health threats regulatory framework and discuss opportunities for further EU action. Based on a comparison with other EU crisis management mechanisms (the Banking Union, risk preparedness in the electricity sector and food safety), we discuss different crisis decision-making and coordination models and their potential applicability to the health sector. We then formulate several propositions to strengthen Decision 1082/2013/EU on serious cross-border health threats to streamline ex ante pandemic preparedness and organise emergency responses.

Dix ans après l’Obamacare, le système de santé étasunien reste l’un des plus chers et des plus inégalitaires de l’OCDE. La réforme de 2010 a néanmoins ouvert la voie à l’idée d’une assurance maladie universelle. Cette solution peut-elle prévaloir sur l’option publique, un approfondissement de l’Obamacare défendu par les modérés du parti démocrate ?

in Health Policy Publication date 2020-05
DEMERITT David
GRIFFITHS Alexander
ROTHSTEIN Henry
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Despite widespread faith that quality indicators are key to healthcare improvement and regulation, surprisingly little is known about what is actually measured in different countries, nor how, nor why. To address that gap, this article compares the official indicator sets–comprising some 1100 quality measures– used by statutory hospital regulators in England, Germany, France, and the Netherlands. The findings demonstrate that those countries’ regulators strike very different balances in: the dimensions of quality they assess (e.g. between safety, effectiveness, and patient-centredness); the hospital activities they target(e.g. between clinical and non-clinical activities and management); and the ‘Donabedian’ measurement style of their indicators (between structure, process and outcome indicators). We argue that these contrasts reflect: i) how the distinctive problems facing each country’s healthcare system create different ‘demand-side’ pressures on what national indicator sets measure; and ii) how the configuration of national healthcare systems and governance traditions create ‘supply-side’ constraints on the kinds of data that regulators can use for indicator construction. Our analysis suggests fundamental differences in the meaning of quality and its measurement across countries that are likely to impede international efforts to benchmark quality and identify best practice.

in Regulation & Governance Publication date 2020-05
WESSELING Mara
DEMERITT David
ROTHSTEIN Henry
PAUL Regine
HUBER Michael
HERMANS Marijke
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This article advances scholarship on comparative regulation by moving beyond the conventional focus on formal law and EU comitology to assess the extent of ‘practice convergence’ in the implementation of EU regulation. Drawing on 50 key informant interviews, a survey, and policy document analysis, we compare how regulators in England, Germany, France and the Netherlands have implemented EU requirements that food safety inspections be ‘risk-based’. Focusing on a clear dependent variable – risk-scoring methods – we find important differences in the conception and targeting of risk-based inspections; with starkly different implications for what kind of food businesses they need to target to ensure safety within an ostensibly harmonized single market. We attribute variation in the implementation of risk-based inspection to the ways that EU requirements were filtered through long-entrenched regulatory styles and modes of food business organization in each country, reinforcing preexisting inspection practices in the design of new risk-based tools.

in Journal of Health Politics, Policy and Law Publication date 2018-09
SPARER Michael
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Critics of the US health system argue that a higher proportion of the health dollar should be spent on public health, both to improve outcomes and to contain costs. Attempts to explain the subordinate status of public health in America highlight such factors as distrust in government, federalism, and a bias toward acute care. This article considers these assumptions by comparing public health in the United States, England, and France. It finds that one common variable is the bias toward acute care. That the United States has such a bias is not surprising, but the similar pattern cross-nationally is less expected. Three additional findings are more unexpected. First, the United States outperforms its European peers on several public health metrics. Second, the United States spends a comparable proportion of its health dollar on prevention. Third, these results are due partly to a federalism twist (while all three nations delegate significant responsibility for public health to local governments, federal officials are more engaged in the United States) and partly to the American version of public health moralism. We also consider the renewed interest in population health, noting why, against expectations, this trend might grow more quickly in the United States than in its European counterparts.

in Socio-Economic Review Publication date 2017-09
ROTHSTEIN Henry
DEMERITT David
PAUL Regine
WESSELING Mara
DE HAAN Maarten
HOWARD Michael
HUBER Michael
BOUDER Frederic
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This article tests the extent to which the organization and stringency of occupational health and safety regulation complements the dominant mode of coordination in the political economy. While the UK explicitly sanctions risk-cost-benefit trade-offs, other European countries mandate ambitious safety goals. That contrast appears to reflect cleavages identified in the Varieties of Capitalism literature, which suggests worker protection regimes are stronger in coordinated market economies than in liberal market economies. Our analysis of Germany, France, UK and the Netherlands, shows that the varied organization of their regulatory regimes is explained through a three-way complementarity with their welfare systems and modes of coordination. However, despite varied headline goals, we find no systematic differences in the stringency of those countries’ regulatory protections insofar as they all make trade-offs on safety. Instead, the explicitness, rationalizations and logics of trade-offs vary according to each country’s legal system, state tradition and coupling between regulation and welfare system.

in Revue internationale de politique comparée Edited by BEAUSSIER Anne-Laure, BENDJABALLAH Selma Publication date 2014-03
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