Healthcare governance, professions and populism: Is there a relationship? An explorative comparison of five European countries

Abstract

A new wave of support for populist parties and movements represents a serious threat to universal healthcare coverage in traditional liberal democracies and beyond. This article aims to contribute empirical material on the relationships between healthcare governance, professions and populism. It applies an explanatory cross-country comparative approach and uses mixed methods, including micro-level data garnered from international comparative databases and documents. Denmark, England, Germany, Italy and Turkey have been selected for comparison, reflecting different types of healthcare systems and populist movements. The results reveal variety in the ways populist discourses impact in healthcare. Abundant economic resources, network-based governance, high levels of trust in healthcare providers and doctors participating as insiders in the policy process seem to work as a bulwark against populist attacks on healthcare and professional expertise. On the other hand, poorly resourced NHS systems with doctors as outsiders in the policy process and major NPM reforms together with low to medium levels of trust in healthcare providers may be fertile ground for populist discourse to flourish. Our explanatory data provide hints of correlations, which may inform further studies to investigate causality. Yet the research highlights that healthcare governance and professions matter, and brings into view capacity for counteracting populist attacks on universal healthcare and professional knowledge.

New public management, physicians and populism: Turkey's experience with health reforms

“…, McKee , Pavolini et al . , Speed and Mannion ). Growing inequality and a backlash against the global goals of sustainable development and universal healthcare coverage are among the major concerns (Gostin and Friedman ).…”

“…Right-wing populism has received a new relevance in many parts of the world. Public health researchers and health systems scholars have highlighted the threats to health and healthcare systems that are embedded in these developments (Greer 2017, Jarman et al 2018, McKee 2017, Pavolini et al 2018, Speed and Mannion 2017. Growing inequality and a backlash against the global goals of sustainable development and universal healthcare coverage are among the major concerns (Gostin and Friedman 2017).…”

“…This article focuses on the nexus between professions/professionalism and NPM policies in the context of rising concerns over right-wing or neoliberal populism using Turkey as a case study. Turkey provides an interesting case because of its particular combination of NPM reforms since the early 2000s with a populist narrative of political leaders that portrays the physicians as part of the old elite and explains their reaction to the reforms in terms of a refusal to give up their privileges (Agartan 2015, Pavolini et al 2018. Therefore, this case study makes it possible to analyse both specific forms of new governance mechanisms and different populist discursive tools.…”

The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts

“…However, these innovations are embedded in wider health system contexts that are often characterised by organisational fragmentation and siloed functioning 2–4. The ‘disarticulated state’5 is the end result of a variety of forces impacting health systems in both the global north and south: proliferation of donor aid and vertical health programmes in the Millennium Development Goal era,6 New Public Management reforms and the splitting of purchaser and provider functions,7 8 various forms of decentralisation and the growth of private (for profit and non-governmental) health sectors 4 8. The prevailing institutional norms and incentives in many health systems are to compete rather than collaborate.…”

A people-centred health workforce in Europe: How to make it happen?

“…Both cases highlight the potential threats that health workforce mobility and migration represent to less well-resourced healthcare systems in Europe. The final article directs our attention to the changing political landscapes and explores, in a comparative perspective, possible relationships between healthcare governance, professions and populism in EU countries [13].…”