The Health Care Policy Quadrilemma and Comparative Institutional Reforms

Abstract

Over the last two decades, health care systems have been put under various types of pressure. The most visible one has, of course, been economic pressure, with health care spending continuing to grow much faster than GDP. But health care systems have also been challenged from a social point of view, since, in many countries, the debate about inequalities in health conditions has become increasingly relevant. Finally they were also confronted with the necessity to adapt to changes in the pathologies. The last decades have seen a shifting from acute diseases to chronic ones, while medical technologies changed radically.