Health care privatization processes in Europe: Theoretical justifications and empirical classification

André, Christine; Batifoulier, Philippe; Jansen-Ferreira, Mariana

doi:10.1111/issr.12092

Cited by 26 publications

(10 citation statements)

References 11 publications

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“… 1 It can take different forms, including privatising services provision and health care finance, or transferring ownership from public to private. 2 , 3 Early efforts to privatise health care systems started in developed countries; since then, developing countries have taken cues from them to privatise their health care systems. 4 , 5 International agencies, such as the World Bank, play a major role in supporting privatisation in low-income developing countries, 5 and countries in Europe 2 , Latin America 6 and Asia 7 , 8 have seen privatisation as the solution for overcoming the financially burdened, inefficient and unsatisfactory public health care systems.…”

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confidence: 99%

Autonomy, accountability, and competition: The privatisation of the Saudi health care system

Al-Mubarak

Alfayez

Alanazi

et al. 2021

Journal of Taibah University Medical Sciences

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Objectives This study aims to explore the perceptions of different stakeholders about the privatisation of the Saudi health care system. Methods Using a qualitative case study design, we interviewed 21 administrators and clinical staff of a public hospital in the Eastern Province of the KSA and analysed all official documents relevant to this study. The analysis followed a thematic approach to provide an in-depth interpretation of the data. Results Our analysis generated three main themes. The first was pertinent to the changes in the governance structure, with gradually increased autonomy from the government. The second reflected the necessity to introduce accountability within hospitals. The third described the cooperative relationship among the E1-Cluster hospitals as well as its competitive relationship with the private sector. Conclusion Our study demonstrates the interplay between newly introduced concepts of autonomy and accountability within the Saudi health care system. The findings of this study and their implications for research, practice, and policy are elaborated. Such an understanding is essential to improve the implementation process of privatisation and to recognise new dynamics that are shaping the health care system. The study contributes to the current scarce literature on health care reforms in KSA by reporting perceptions and experiences of key stakeholders.

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confidence: 99%

Autonomy, accountability, and competition: The privatisation of the Saudi health care system

Al-Mubarak

Alfayez

Alanazi

et al. 2021

Journal of Taibah University Medical Sciences

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“…The reconfiguration of the socialised and private financing of healthcare in France represents a political decision that has transformed the role of national and complementary health insurance. Understanding this means, in the first instance, identifying the theoretical and ideological principles of the movements towards the privatisation of healthcare systems (André et al 2016), in particular the various strategies for competition that can be identified in the recent transformations undergone by the Bismarckian health insurance schemes (Hassenteufel and Palier 2007), and an institutional complementarity between the two major types of health insurance (3.1.). The first term enables several successive governments of different political parties to contribute to this reconfiguration by sharing a single representation of the problems facing the French health insurance system and therefore the solutions to be employed to resolve them.…”

Section: A Political Option That Redefines the Distribution Of Welfare Resourcesmentioning

confidence: 99%

In Between the Market and Public Health Insurance: A Place for Occupational Welfare in Europe?

Houssoy

Sol

Martin

2020

Private Health Insurance and the European Union

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There is a growing body of studies emphasising the multi-pillar configuration of protection against social risk in Europe, particularly in pension reform. In this chapter, we try to expand on this literature to find applicability beyond the sole case of pensions by looking at the case of occupational health insurance in France. In order to do so, we present a restatement of the pillar/provision perspective in order to apply it to a broader range of cases. We argue it is a powerful analytical tool provided it is complemented with a (non-exhaustive) list of perspectives widely used in studies on social policy and does not blunder into the pitfall of functionalism. The chapter focuses on crossing the pillar perspective with a finance and also a regime perspective. Following the seminal intuition of R. Titmuss, an important result yielded is that the overall structure of resources distribution of the whole welfare system can become highly anti-redistributive once occupational schemes and fiscal incentives are included in the analysis.

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“…Indeed, and since the 1980s, one can note a stagnation of the share of health spending paid for by NHI. This shift coincides with the first mentions in reports and legal texts of the field of “complementary health insurance,” a field that “should be organized and regulated.” The creation of CMU‐C and UNOCAM is seen as institutionalizing this “scrambling” trend by reinforcing the integration between private and public insurance—and offering the basis for further disengagement from the public sphere. Without necessarily rejecting this interpretation, other specialists insist that PHI homogenization and recognition have been paralleled by a process of “statization” or “technocratization” of NHI governance .…”

Section: French Private Health Insurance: a Review Of Recent Reformsmentioning

confidence: 99%

Private Health Insurance in France: Between Europeanization and Collectivization

Benoît

Coron

2019

Milbank Quarterly

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Private health insurance (PHI) in France has been facing critical changes over the past 30 years. A complementary and voluntary scheme, it has been historically dominated by nonprofit entities. However, the share of for‐profit insurance companies in the sector has significantly increased. Nonprofit firms also changed their strategies and mimicked some for‐profit behaviors. The present paper argues that this process is a result of the conflict‐provoking coevolution of the insurance and health care sectors. Trying to improve the regulation of the insurance industry as whole, two European directives first jeopardized the business model of nonprofit entities. Then, two national reforms designed to improve health coverage significantly increased competition among insurers, notably in the area of corporate‐level contracts. Decoupling the insurance and health care sectors has become a major source of policy feedback and unexpected outcomes of reforms affecting the very organization of PHI. Context In France, private health insurance (PHI) has an exceptionally high level of coverage and accounts for 13.7% of health expenditures. A complementary and voluntary scheme, it has been historically dominated by nonprofit, mutual benefit societies. Over the past 20 years, however, the market share of for‐profit insurance companies has increased by 47%. Financialization of the field developed, and competition based on new risk management strategies also increased. The broad aim of this paper is to characterize and to elucidate the causes of this trend. More specifically, we are interested in how and to what extent a series of supranational and national policies contributed to this situation. Method Our data come from three sources. We first reviewed documents published by health insurers, government reports, and newspaper articles. We then conducted two semistructured interview campaigns between September 2017 and May 2018. The first mostly covered private and public actors and their involvement in European Union (EU) policymaking (n = 21). The second series of interviews was conducted with another group of actors directly involved at the French level (n = 16). Findings Our findings support preliminary observations. PHI in France, we argue, is indeed facing a development of competition and marketlike instruments. Four major policies (two EU directives and two national reforms) played a significant role in this outcome. Surprisingly, however, it has never been the purpose of legislators and policymakers: while EU directives created a regulatory framework for insurance activities within the Single Market, policies adopted at the national level initially aimed at improving health coverage. We show that it is the interactions and the noncoordination among all of these policies that explain their unexpected outcome. Conclusions The trend described in this paper is twofold. The first is Europeanization, as PHI in France is increasingly affected by EU legislation. Since this framework tends to favor larger firms and for‐profit companie...

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Health care privatization processes in Europe: Theoretical justifications and empirical classification

Cited by 26 publications

References 11 publications

Autonomy, accountability, and competition: The privatisation of the Saudi health care system

Autonomy, accountability, and competition: The privatisation of the Saudi health care system

In Between the Market and Public Health Insurance: A Place for Occupational Welfare in Europe?

Private Health Insurance in France: Between Europeanization and Collectivization

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