Threats and challenges to South European health care systems in the time of crisis

This paper develops a comparative review and analysis of health care in SE in the time of austerity. Escalating public debt in Greece and (to a lesser extent) in Portugal barred their governments’ ability to borrow, and made necessary a bailout plan under tripartite supervision by the EC-ECB-IMF. Spain is close to a “tipping point” that might require international aid, while fears heighten about Italy edging towards a deepening crisis. Confronted by severe budgetary pressures (and the austerity demands for the bailout loans), SE countries introduced recently a wide range of health policy responses. The focal question is whether fiscal retrenchment provides a politically opportune time to drastically curtail public health care; or, instead, are there any signs of reforms embracing (to one extent or another) longer term strategies for potentially balancing fiscal targets with enhanced value, efficiency and health outcome of the reformed public systems, when eventually growth resumes.

The first part outlines the profile of health care systems in the four countries, their diverse paths and common concerns, and identifies a range of factors impinging upon reform. The second part examines the magnitude of fiscal constraint in health care, how this is politically (and ideologically) framed, and how far drastically receding public provision overrides any long-term views on system adequacy.  The third part focuses on the health policy tools deployed and ensuing changes in funding (public/private), the breath and scope of statutory provision, regulation, and working conditions of health care professions. The effects of the austerity-driven reforms on current and excepted policy outcomes (e.g. health status and inequality, responsiveness, quality etc.) are briefly assessed too. The paper concludes with reflections on the future of the public health care systems in the European periphery vis-à-vis EU-wide trends and challenges.