Friday, March 14, 2014
Empire (Omni Shoreham)
South European (SE) public healthcare systems have confronted an unprecedented stress-test in the past few years. This paper develops a comparative review and analysis of health care in SE in the time of austerity. The focal question is whether fiscal retrenchment provides a politically opportune time to drastically curtail public health care; or, instead, there are 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. Thus, the paper aims at eliciting what mix of retrenchment, restructuring and recalibration strategies have been adopted as well as analysing comparatively whether the trajectories of the four SE countries have been convergent or divergent. The study is divided into three sections. The first section outlines the evolution of health care systems in the four countries prior to the crisis and their diverse paths and common concerns. The second section examines the magnitude of fiscal constraint in health care and how this is politically (and ideologically) framed. The third section 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 expected policy outcomes (e.g. health status and inequality, responsiveness, quality etc.) are briefly assessed too. The paper concludes with a comparative assessment of reform trends under harsh austerity.
