This article analyses the health care system reform process in Europe based on the concept of privatization. This notion is understood from two perspectives. First, privatization may concern the health care financing or the provision of health services. Second, privatization can be "imposed" on individuals or be "internalized" and then introduced by individuals (patients and doctors). So we emphasize the diversity that privatization can assume. We classify privatization mechanisms used by different countries and identify which of the perspectives presented are more common in 14 European Union countries since the 1980s. The article shows that even if privatization processes are widespread, they assume different patterns in each country.
Résumé Cet article propose une lecture comparée de deux évolutions parallèles majeures de la politique de santé : l’autonomisation du patient et la régulation par la demande. Une première tendance de fond est de prendre en considération le patient comme acteur autonome. Dans les faits, l’émergence d’un patient actif s’est traduite par la structuration d’un droit des patients privilégiant le droit à l’information et la recherche du consentement éclairé. Simultanément la politique économique met l’accent sur la demande dans la régulation de la dépense de santé. Cette double évolution conduit à l’émergence d’un consommateur de soins. Elle s’appuie sur la structuration d’un consommateur souverain car informé, évaluant des produits de santé standardisés (panier de soins) et des services spécifiques (médecin traitant). Cette analyse s’interroge sur les implications de ces transformations, en termes d’efficacité et d’équité.
In this paper, we argue that the welfare state is an outcome of modern mass (total) warfare. The total war economy requires the participation of all citizens, erasing the difference between the military and citizens. Consequently, the war economy benefits from supporting the civilian population. The total war effect explains why a predatory state undertakes welfare programs. This is one of the contributions of the present paper.While welfare state is closely related to total warfare, social welfare is not. Fraternal social welfare in the United States preceded the New Deal and the rise of welfare state. Similarly, the French welfare system was born as citizen welfare and not state welfare. In fact, welfare programs were initiated in 1871 during the Paris Commune by workers under the name of la sociale, and it was established as a self-managed citizen welfare in 1945 before being displaced by government welfare programs. A second contribution of this paper is to explore the reappropriating effect or the way self-managed citizen welfare was transformed into a welfare state through a three stage process of reforms in 1946, 1967, and 1996. JEL Codes: D6, D74, H1, H53, N4, O1Our general theory builds upon path dependency models of welfare spending (Olson 1982;Holcombe 2005) and the vast literature on the symbiotic relationship between total war and the welfare state within a predatory approach to the state (Vahabi 2016a, b). Welfare spending increases the state capacity to engage in a total war. Since internal political stability is a prerequisite for victory in the war, all types of governments including military ones seek to insure mass compliance for achieving the official war goals. Along with nationalistic or patriotic propaganda, and repression pursuing the warfare targets, welfare spending may secure mass loyalty and increase self-sacrifice (see Holcombe 2019 and Leeson 2012, 2013 on the role of ideology). This is what Vahabi (2016b: 161) has called the state's domestication technique. A recent study of New Deal spending and patriotism during World War II lends credence to this idea by showing that "US counties receiving more relief payments during the 1930s bought more war bonds, sent more volunteers to the armed forces, and were home to more soldiers displaying conspicuous gallantry on the battlefield…These results are in line with an interpretation that emphasizes individuals reciprocating towards the nation state if their national government came to their aid in bad times" (Caprettini et al. 2018: 23).While welfare state is closely related to total warfare, social welfare is not. Fraternal social welfare in the United States preceded the New Deal and the rise of welfare state. As extensively documented by Beito (2000), three fraternal types dominated by the late nineteenth century: secret societies, sick and funeral benefit societies. The aid dispensed through organized charities and governments at this time was not only minimal but marked with a stigma. Mutual funds and fraternal societies were based on...
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