The financial crisis and health care systems in Europe: universal care under threat? Trends in health sector reforms in Germany, the United Kingdom, and Spain

Abstract

The paper analyzes trends in contemporary health sector reforms in three European countries with Bismarckian and Beveridgean models of national health systems within the context of strong financial pressure resulting from the economic crisis (2008-date), and proceeds to discuss the implications for universal care. The authors examine recent health system reforms in Spain, Germany, and the United Kingdom. Health systems are described using a matrix to compare state intervention in financing, regulation, organization, and services delivery. The reforms’ impacts on universal care are examined in three dimensions: breadth of population coverage, depth of the services package, and height of coverage by public financing. Models of health protection, institutionality, stakeholder constellations, and differing positions in the European economy are factors that condition the repercussions of restrictive policies that have undermined universality to different degrees in the three dimensions specified above and have extended policies for regulated competition as well as commercialization in health care systems.

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

“…The recession has resulted in increased economic inequality, according to the Gini index 11 . Some health problems, such as major depression, have a clear social gradient and this appears to have steepened during the crisis [32].…”

“…Nevertheless, even in comparison with countries where the crisis was relatively mild, such as the UK and Germany, the measures adopted for the Spanish healthcare system were not especially drastic [11].…”

"Austerity" in the English National Health Service: fragmentation and commodification - examples not to follow

“…This insidious and continuous commodification muddles the borders between public and private 19 and threatens both the sustainability of the NHS as a comprehensive universal public system and the guarantee of the right to health 4,8 .…”

“…Healthcare is still financed with public resources, predominantly taxes. Public spending in health in 2013 accounted for 85% of all health spending and represented 7.3% of GDP, with little variation in recent years 4,18 .…”

“…In the wake of the international financial crisis, beginning in 2010 the conservative-liberal David Cameron government implemented austerity policies to "consolidate" the public budget, centered on spending cuts, including in health 4 . The Health and Social Care Act of 2012 5 was passed, with the broadest and most dramatic reform of the NHS since its creation in 1948.…”