Regional health budgeting in Western Europe.

This article distinguishes in the first section three characteristics of regional budgeting in health care systems: geographical division of budgets, regional financial limits, and policy freedom for regional authorities. Following these and more general elements of regional budgeting systems sections 2 to 5 describe the situation in the U.K., Sweden, The Netherlands, and some other European countries. The first two countries have a developed regional budgeting system for health services paid by taxation. Other European countries are developing regional budgeting models which are to be combined with a social insurance system. Of these countries, the Netherlands are discussed in some detail. Based on the experiences with regional budgeting in different countries three hypotheses are generated which require further empirical research. They are: (1) One management tier on a regional level--or municipal or provincial level--is a condition for a regional budgeting system which contributes more to an integration of health services than a two-tier system. (2) Countries with a regional budgeting system with a regional financial limit superimposed by the state seem to spend a smaller percentage of their gross national product than other countries. (3) Countries with policy freedom on a local level show a faster growth rate for primary care than for hospital care.