Public or private healthcare? Multi or single-payer systems? The reality of European health care systems is much more nuanced and requires a deeper analysis of how health politics has been managed on the continent during the last 30 years.
Health Politics in Europe, a new handbook published by Oxford University Press and co-edited by EUI Chair in Political Sciences, Professor Ellen M. Immergut, Max Weber Fellow Tamara Popic (now starting at Queen Mary University of London) and colleagues Karen Anderson, University College Dublin, and Camilla Devitt (EUI PhD), Trinity College Dublin, seeks to tell this precise story.
The book provides a political narrative of the development of healthcare policy and politics in and throughout Europe, including countries and regions that have not been systematically studied before. This immensely detailed work and the accompanying datasets and online Appendix provide the definitive history and up-to-date information and analysis on health politics and health systems in 35 European countries, in 7 European regions.
The end of the Cold War initiated massive changes in European health systems, with Eastern European countries launching transitions from state-run healthcare towards post-communist public-private mixes, while Western European policymakers experimented with new public management and other market-oriented health reforms. Yet efforts to draw lessons from this period of experimentation have been hampered by a tendency of researchers and policymakers to focus their attention on a very narrow set of (largely English-speaking) countries.
The editors of this handbook were motivated by the need to close this information gap, particularly by including Eastern and Southern Eastern European countries, and to make the bewildering variety of data on inputs and outcomes comparable across countries. “Only if this is done can we have productive discussions about choices and reforms – which health care services, features and systems work and which do not,” notes Ellen Immergut, the lead editor and project leader.
In defining its geographical landscape, the handbook divides Europe into seven regional sections, each of which gets its own outlook chapter with comparative data on health system financing, healthcare access and the political salience of health. A brief discussion of common characteristics and divergent paths taken by the separate countries in the region is duly included. The core of each country case traces the politics of health policy since 1989, examining key reforms and their impact on public opinion and political legitimacy.
Takeaways and Insights
The overall picture depicted is quite positive. In the last 31 years, more people have been covered for health services and are less vulnerable to unpredictable health costs. Infant mortality and treatable mortality have declined, while life expectancy has increased. Data from the European Social Survey shows that people’s levels of satisfaction with their health care have increased, somewhat slower in the East than in the West, but still noticeably. All things considered, the European healthcare model can be seen as a success, even though there will always be more to do.
As far as the recent pandemic is concerned, the authors are still processing the early data on impacts and policy reactions to Covid-19. So far, other scholars have observed that certain countries handled the initial outbreak better than others, but that coping performance changed as the pandemic progressed.
The data included in the handbook can provide some intriguing insights regarding this aspect. For example, more important than the overall features of the health care system in place was the government’s policy smarts and decision making. From the perspective of the pandemic’s first 15 months, “those leaders who used the strengths of their existing system were able to better protect their citizens’ health, prepare for future shocks and minimize the damage.”
Finally, the impressive dataset developed from the handbook provides the definitive history and up-to-date information and analysis on health politics and health systems throughout Europe. The unprecedented level of empirical data was indeed possible thanks to the contributions of several early-stage researchers at the EUI and alumni, including Edgars Eihmanis (EUI PhD, Research Fellow), Simonida Kacarska (STG Policy Leader Fellow), Alexandru Daniel Moise (Max Weber Fellow), Andra Roescu (Max Weber Fellow), Mi-Ah Shoyen (EUI PhD), Guergana Stolarov-Demuth (EUI Research Fellow), Christiaan Vermorken (EUI PhD), Mirko Wegemann (EUI PhD), Blerta Begisholli (EUI PhD), Mariana Carmo Duarte (EUI PhD), Daniel Fernandes (EUI PhD) and Rebecca Kittel (EUI PhD). EUI information specialists Thomas Bourke and Peter Kennealy provided support for the data repository and the final corrections on the manuscript.
The dataset is freely accessible on Cadmus, the EUI’s institutional repository, and on the EUI’s Covid Knowledge Hub, while the Online Appendix is available on the OUP Companion website.
Of particular interest is the Guide to Data and Sources, which targets the key indicators for various aspects of health systems and health politics, such as “unmet need,” “satisfaction with health services,” “political salience,” and the “public-private mix.” The Guide characterises health systems in terms of four financing pillars identified by the OECD: taxes, social insurance contributions, private health insurance, and individual out-of-pocket payment. This is particularly relevant for researchers to observe both regional trends and individual country and over time variation.