Many European countries are reviewing their health care systems and the suitability of their existing approaches to financing, organizing and delivering health care services. As health care reform is deeply associated with the normative, economic and organizational characteristics of each country, programs to achieve better expenditure control and greater productivity and efficiency need to be balanced with solidarity principles, such as equal access.
In order to attain this difficult goal, most western European countries have tried to adopt contract-based health care reform. Contracts define the relationships between different categories of participants in the health care system. Two approaches are used for contracting. First, contracting is used as an instrument of health care planning and management in both competitive (i. e., the UK and the Netherlands) and non-competitive environments (i. e., France and Germany). For this purpose, contracting is regarded as the formalization of the planning and management process. Second, contracting is regarded as a tool for increased choice of providers (i. e., the UK and Sweden). Although the cost-containment effect of contracting is still unclear, most European countries formalize the contracting within their health care reforms. Along with the implementation of the contracting approach, most European countries have developed a health information system that is indispensable for contracting procedures. In particular, hospital information systems based on casemix classification are widely adopted (i. e., Nord-DRG in the Nordic countries, GHM in France, AR-DRG in Germany, HRG in the UK).
In summary, policymakers in most European countries are moving away from command and control strategy and are placing greater emphasis on accountability and contestability through the development of contracting mechanisms.