Southern European Health Systems Transformed by Economic Crisis

A new study reveals that Southern European (SE) countries are undergoing a dangerous, perhaps irreversible, process in both the funding and provision of healthcare.

Researchers at Democritus University (Xanthi, Greece), the University of Macerata (Italy), and the University of Oviedo (Spain) traced the common trajectories followed by four SE countries—Portugal, Greece, Spain, and Italy—during the recent economic crisis. By measuring public dissatisfaction and studying the processes behind certain healthcare practices, the researchers found that imbalanced methods to bridge gaps in healthcare access, shortages in funding and research, and divisions in equality are endangering SE public healthcare systems.

While all four countries introduced a universal health system in the late 1970s to early 1980s, the transition from health insurance to a national health service (NHS) took place at a different pace and involved a varying scope of coverage in each country. While Spain and Italy succeeded in forming more “progressive” public healthcare systems along universal principles, Greece and Portugal did not reach the state of a fully fledged NHS, and in both countries healthcare remained fragmented, with a mixed system continuing to operate; an occupation-based health insurance system was combined with an NHS, but private provision was also expanding.

When the crisis hit these countries, exacerbated NHS fiscal sustainability problems were added to citizens' dissatisfaction problems of quality, access, and affordability. In Portugal, and particularly in Greece, defective integration among the different parts of the system further intensified strains. Fiscal retrenchment and cost rationalization became key priorities and, for the bailout countries, major stipulations of the rescue deals included severe contraction measures, from freezes to severe cuts in the per capita public healthcare expenditure.

This was accompanied by cuts in private expenditure of 30%–40% in households belonging to the seventh, eighth, and ninth income deciles. Cuts were particularly harsh among households where the head is self-employed or a manual worker. Together with the drastic rolling back of public health expenditure, a deepening gap between the bottom/middle income groups and those at the top of the income hierarchy developed with respect to covering medical needs, with the number of households that cannot afford to buy drugs tripling since 2007.

The researchers concluded that even though none of the four countries has openly embarked upon systemic change to dismantle the public system, the austerity-driven measures may add up to a transformative process that may trigger such a policy drift and/or exhaustion process, whereby the publicly operating system gradually withers away as large-scale public spending cutbacks and a range of policy measures shift the cost of healthcare away from the state. The study was published in the Fall 2014 issue of for South European Society and Politics.

“The shift of a large part of primary healthcare to private providers make a scenario of drastic retrenchment of public healthcare provision in SE countries highly likely,” wrote coauthor Professor of Social Policy Maria Petmesidou, PhD, of Democritus University, and colleagues. “Whether this is an irreversible trend is an open question, though there have been no signs so far of balancing fiscal savings and efficiency gains with attempts to improve access and quality.”

Related Links:
Democritus University
University of Macerata
University of Oviedo