Introduction: Special Issue on Innovations in Health Care System Reform in OECD Countries

Health care systems can be seen as a house, with financing and service provision as two pillars resting on a foundation of shared values, perceptions and guiding principles. The roof would then represent the regulation of the interactions between service providers, financing agencies, and potential beneficiaries such as patients (Rothgang et al., 2010: 11). Health care systems in the Organization for Economic Cooperation and Development (OECD) countries seem to be in a state of permanent change, i.e. they seem to continuously strive to adjust to economic, political, and social demands. Indeed, the economic recession that followed the oil price shocks of the 1970s marked the end of the Golden Age of the welfare state and triggered a range of cost containment measures in OECD countries that have continued over four decades up to the present. Currently, the OECD health care systems have to deal with a new phase of economic turmoil brought on by the most recent financial crisis (Starke, 2007). According to Rothgang and colleagues (2010), this doesn't mean that OECD countries have had an easy time curtailing public financing and implementing reduced welfare policies. This observation is particularly meaningful for the health care sector because its legitimacy relies on its ability to provide a satisfactory standard of health care for all citizens, regardless of their ability to pay for care.Because of demographic and epidemiological realities, as well as widening health inequalities and advancements in medical technology that increase the demand for health care, OECD countries face challenges deciding the amount of public funds that should go to health services. Consequently, there has been an increase in demand for reforms which ensure cost containment while allowing high quality health care services for populations (Rothgang et al., 2010). However, the introduction of reforms has translated into a change in the role of state health care provision, financing and regulation. Indeed, for most OECD countries, health is typically the largest area of government expenditure, after social protection, and is one of the main areas of public expenditure projected to come under additional pressure (Frisina, 2008; Hernandez de Cos and Moral-Benito, 2014; Rothgang et al., 2010).Most countries have recently adopted reforms enhancing the role of markets in their health care systems, notably through the introduction of the public contract model, competition among providers as well as among third-party purchasers, in addition to the reinforcement of consumers' choice of provider (Freeman and Schmid, 2008; OECD, 2011). Despite enduring differences at the systemic level, most countries have reformed their health care systems along these lines. Although health systems have delivered big improvements in health, they can be slow to adapt to new challenges. Reform efforts to date have not been sufficient to deal with many of the underlying pressures contributing to spending growth. In light of these developments, what are the characteristics of the OECD health systems? What are global health systems challenges? How does the value of money translate into health care systems? What is the role of innovation in reforming health care systems?Characteristics of OECD health systemsThe response to various socio-economic pressures have differed considerably across health care systems types; in fact OECD countries have resorted to a wide variety of institutional arrangements to provide health insurance coverage and to finance and deliver health care while responding to these pressures (OECD, 2011; Rothgang et al., 2010). Interestingly, evidence shows that OECD countries share common challenges and experiences. We release here some characteristics of OECD health care systems in relation to health care insurance and financing while also describing the relationship between insurance/financing and delivery systems.The range of health care services covered by basic (primary) health care coverage (i. …

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