Health care expenditure currently represents an average of 9 % of GDP in OECD

countries, and it continues to increase, notably as a result of progress in medical

techniques, the ageing of the population and also people's growing demands vis-à-vis

the health care system. Yet all Western countries have undertaken reform of

their health care systems.

What are the objectives and issues of the reforms adopted by European countries

since the 1990s? Analysis of the reforms presented in this issue reveals a common

objective: to regulate health care systems in order to contain expenditure whilst

ensuring the highest quality of health care and, if possible, its equitable distribution,

and encouraging innovation. Measures implemented by European countries

aimed at meeting these objectives are diverse. They vary according to the history

and age of the system, its nature (whether inspired by the Bismarck or the

Beveridge system), and the role attributed to the private sector and to public,

central and local authorities.

Two orientations have nonetheless clearly emerged since the beginning of the

1990s:

- the decentralisation of the decision-making and management of the health care

system, a process that can take many forms and produce varying results, notably

because of power struggles;

- the introduction of competitive mechanisms (between health care insurance providers

and health care providers), a form of competition that is often regulated by

public authorities in order to protect policyholders.

Pinpointing the differences between European systems, in terms of both means

and results, enables us to speculate on new ways to improve access to quality

health care, at a cost that is affordable for both the individual and society, and to

ensure the sustainability of the health care system.