**Acknowledgements**

of outpatient healthcare; the access to doctors is highly regulated, and doctors face strict regu-

(iii) The *low-budget restricted access* health systems are characterized by low level of total health expenditure which is related to the weaker economic position of these countries, high private out-of-pocket payments, high control of patients' access to medical doctors, low level of inpatient, and moderate level of outpatient healthcare; GPs receive in general a fixed salary, and

(2) In the following year, another analytical typology is proposed by Reibling [24] who introduced new criteria for grouping national health systems. In particular, this author considered gatekeeping, cost-sharing, provider density (GPs, specialists, and nurses), and medical technology (magnetic resonance imaging units/MRI and computed tomography scanners/CT) as dimensions of classification. This author has based his proposal in cluster analysis over eigh-

(i) *Financial incentives states* that regulate patients' access to medical doctors mainly by costsharing, and there is a high availability of GP, nurses, and medical technology; (ii) *strong gatekeeping and low supply states* with no cost-sharing but extensive gatekeeping arrangements for doctor's visits, low numbers of health-care providers, relatively little medical technology, and some regulatory emphasis on provider density and technology; (iii) *weakly regulated and high supply states* with weak gatekeeping and a high supply of health-care providers; (iv) *mixed regulation states* that combine gatekeeping and cost-sharing arrangements, so there is a strong access regulation; physician densities are moderate, and medical technology is highly available. (3) Finally, Joumard et al. [25] use a set of 22 indicators on institutional features to create a typology of health-care systems. The variables used in this analysis are several, and they may be grouped in those capturing: (i) the reliance on market mechanisms and regulations to steer the demand and supply of health care, (ii) coverage principles to promote equity, and (iii) budget and management approaches to control public spending. The authors perform a cluster analysis and find six groups of health-care systems: Group 1—private provision and private insurance for basic coverage; Group 2—private provision, public insurance for basic coverage, private insurance beyond basic coverage, and some gatekeeping; Group 3—private provision, public insurance for basic coverage, little private insurance beyond basic coverage, and no gatekeeping; Group 4—public provision and public insurance, no gatekeeping, and ample choice of providers; Group 5—public provision and public insurance, gatekeeping, limited choice of providers, and soft budget constraint; Group 6—public provision and public

insurance, gatekeeping, ample choice of providers, and strict budget constraint.

Classifying national health systems has been a need of researchers to order and study the diversity of the observed reality. In the last 30 years, the European health systems have been classified according to several criteria which generated a set of different typologies. In this article, the most relevant typologies are presented. Six non-analytical typologies are presented. These typologies' main differentiating factor is the number and the type of criteria used to

lation regarding their income arrangement.

64 Advances in Health Management

income is strongly regulated and controlled.

teen indicators and ended up finding four clusters:

**4. Conclusion**

The author acknowledges the fellowship from EURO\_HEALTHY project, European Union's Horizon 2020 grant agreement nr: 643398.
