In view of the continuing preoccupation of all industrialized countries with the rising share of national resources devoted to health care, it is valuable to compare the fmanc ing and breakdown of health care expenditure on an international basis. How far should public spending on health care be regarded as a capital investment in the improvement of the health of the population and how far as subsidies to individual consumption? This question is of major importance to policy makers, including the me dical profession, politicians, employers, social security officials as well as to the public at large. In order to obtain some insight into the incentive structures enhancing competition among suppliers which have been built into the health care delivery systems in the various countries, the Interdisciplinary Research Centre for Public Health at St. Gall, in close co operation with the Institute of Insurance Economics and the Institute of Public Finance and Fiscal Law, both afftliated with the Saint Gall Graduate School of Economics, Business and Public Administration, initiated an international seminar held at Wolfsberg, Switzerland, 20-23 March 1979. The purposes of the Seminar were: 1. to review present experience on the development of health care costs and their financing - particularly the role of health insurance and the institutional relationships between public !illd private health insurance policies; 2.

Preface

Report on the Seminar
1. The Rising Costs of Health Care
2. Alternative Strategies of Cost Containment Which Have Been Adopted, Other Than Cost-Sharing
3. The Role of Cost-Sharing
4. Forms of Cost-Sharing by the Patient
5. The Case for Cost-Sharing
6. The Case Against Cost-Sharing
7. Cost-Control by Consumer Choice and Competition
8. Conclusions
Conclusions and Summary of a Panel Discussion
Appendices
1. Papers Presented at the Seminar
A.C. Enthoven: Health Care Cost Control Through Incentives and Competition
U. Geissler. Health Care Cost Containment in the Federal Republic of Germany
M. Haller: Possibilities of Adapting the Risk Management Approach for Use in the Health Care System
R.S. Hanft, J. Eichenholz: Hospital Cost Containment in the United States
H. Hauser: Health Care Cost Control - A Conceptual Framework
H. Hauser, K. Koch: Health Care Expenditure and Its Financing - An International Survey
B. Horisberger: Dynamic Organization of Social Security Systems
U. Müller: Structure and Operation of Switzerland's Health Insurance System
M. Pfaff: Objectives and Forms of Cost-Sharing
S. Sandier: Elements of Social Risks Related to Health
W.P. von Wartburg: Health Services Plus Social Market Economy Equals Social Health Economy
2. Reports of the Workshops
Workshop I: Financial Aspects and Policies
Workshop II: Risk and Insurance Policies
Workshop III: Social Security and Alternative Possible Systems Which Would Lead to Better Value for Money in Health Care
3. List of Participants.