Demography’s contribution to health policy debates comes from the study of population dynamics relating to fertility, mortality and migration. The aim of this article is to stress how vital a correct understanding of population dynamics is for health policy and planning. The article first highlights some of the major contributions demographers have made to debates about health, particularly where they have helped to overcome misconceptions. It then discusses two prominent issues: population ageing in the developed world and population growth in developing countries.

This article proposes a systematic framework for analysis of the increasingly popular concept of user choice in European health systems. The development of such a framework is exemplified using one category of potential choice: the choice of health service provider. In the first part, the paper summarises the conceptual background of the user choice debate. Subsequently, the paper theoretically analyses the concept of user choice alongside a stringent set of standard dimensions embracing technical, administrative and allocative efficiency, as well as equity in access and finance. Reference to available evidence is made where applicable. The employed dimensions are critically discussed and finally mapped against the identified determinants within a systematic matrix framework for analysis. Furthermore, the paper underlines that user choice is by no means a panacea but rather a highly complex and ambiguous political strategy. Extended choice in some sectors and levels of health systems may lead to inefficiencies and may therefore lead to loss of benefits, including choice, for individuals and society.

This paper analyses the influence of recent German health care reforms, the Statutory Health Insurance Modernization Act 2004 and the Statutory Health Insurance Competition Strengthening Act 2007, on different dimensions of access and choice. More specifically, we look at and discuss the effects of these policies on the availability, reachability and affordability of health care as well as on their impact on consumers’ choice of insurers and providers. Generally, patients in Germany enjoy a high degree of free access and a lot of freedom to choose, partly leading to over- and misuse of health services. Concerning choice of insurers, one result of our analysis is that in the statutory health insurance system, the introduction of a greater variety of benefit packages will develop into an additional parameter of choice. In contrast to that, insurees more and more accept certain restrictions of choice and direct access to providers by enrolling into new forms of care (such as gatekeeping-, disease management- and integrated care programmes). However, they might benefit from better quality of care and more options for products and services that best fit their needs.

Studies of the effects of capacity and competition among general practitioners (GPs) on the use of specialist health care services are inconclusive. Some studies indicate that an increase in the number of GPs leads to increased consumption of specialist health care, while other studies point in the opposite direction. This article adds to the literature in two ways; first by testing out different operationalization of capacity and competition among GPs, and then by testing out effects of capacity and competition on use of specialist health care services as this is disaggregated into ambulatory and inpatient activities. The empirical tests indicate that GP capacity in itself does not affect use of specialist health care services. Increased competitions among GPs do, however, reduce the use of ambulatory care while the effects on the use of inpatient services are unaffected.

The purpose of this paper is to describe the characteristics of the high-performing chronic care system and the four implementation strategies needed to achieve such a system. The paper starts with a description of the Chronic Care Model and summarises evidence on its impact. This is followed by a review of international evidence on gaps in the quality of chronic care. These gaps suggest that, useful and influential as the Chronic Care Model is, more is needed to help health care decision makers bring about the reorientation required to meet the needs of populations in which chronic diseases predominate. The second half of the paper therefore sets out the ten characteristics and four implementation strategies required to achieve a high-performing chronic care system. In doing so, it provides practical guidance to policy makers and health care leaders on the most promising strategies for improving the provision of chronic care, drawing on evidence from the experience of England, New Zealand and USA.

Contingent valuation (CV) has been argued to have theoretical advantages over other approaches for benefit valuation used by health economists. Yet, in reality, the technique appears not to have realised these advantages when applied to health-care issues, such that its influence in decision-making at national levels has been non-existent within the health sector. This is not a result of a lack of methodological work in the area, which has continued to flourish. Rather, it is a result of such activities being undertaken in a rather uncoordinated and unsystematic fashion, leading CV to be akin to a ‘ship without a sail’. This paper utilises a systematic review of the CV literature in health to illustrate some important points concerning the conduct of CV studies, before providing a comment on what the remaining policy and research priorities are for the technique, and proposing a guideline for such studies. It is hoped that this will initiate some wider and rigorous debate on the future of the CV technique in order to make it seaworthy, give it direction and provide the right momentum.