The urgency of reform is measured by four indicators:
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a.
The decrease in the life expectancy at the beginning of the 1990s, measured as the relative decrease in life expectancy between 1990 and 1995 (average, per year) (Source: World Data Bank [23])
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b.
The increase in health care expenditure, measured as the increase in percentage of Gross Domestic Product (GDP) between 1995 and 2012 (Source: World Data Bank [23])
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c.
The increase in demand for health care as a consequence of the ageing population, measured as the increase in the percentage of the population over 65 years old between 1993 and 2012 as this is an indicator for an ageing population (Source: World Data Bank [23]).
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d.
The willingness of a country’s population to deliver informal care, measured as the percentage of the population preferring offspring to take care of an elderly father or mother in need of help (Source: TNS Opinion & Social & TNS, 2007 [24])
With regard to politics, we looked at the political composition of governments, measured as the weighted number of years social-democrats or socialists were in power in the period from 1993-2010 (Source: Armingeon et al, Comparative Political Data Set III 1990-2010 [25]) |
The means of a country is measured by the indicators:
-
a.
Government effectiveness, measured as a standardized score, which is made up from, for example, the professionalism of the civil service and the absence of corruption. The mean of the scores between 1996 and 2011 is used (Source: The Quality of Government Dataset [26]).
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a.
The degree of centralization of the health care system, measured as the level of responsibility for the distribution of money in the health care system. Countries where the distribution of money is the responsibility of the central government received a score of 1 and countries where this responsibility lies with multiple parties, such as insurance companies or local regions, received a score of 0. (Sources: Various health care systems in Transition Profiles, European Observatory on health systems and policies)
-
a.
The strength of professional status of GPs, measured as a composite score of the strength of the academic status. This includes: The percentage of either medical universities or universities with a medical faculty with a postgraduate programme in family medicine; family medicine as a subject in the undergraduate medical curriculum; the presence of national associations or colleges of GPs; and the availability of a journal on family medicine or general practice. Each of these indicators received a score from 1 to 3 and the average value was calculated as an indicator for the professional development of general practice in each country (Source: PHAMEU database [27]).
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