Health Politics in Europe

2021 ◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
New Public Management ◽  
Political Legitimacy ◽  
Historical Background ◽  
The Political ◽  
Health Politics ◽  
Health Reforms ◽  
Political Narrative ◽  
European Health

Health Politics in Europe: A Handbook is a work of reference that provides historical background and up-to-date information and analysis on health politics and health systems throughout Europe. In particular, it captures developments that have taken place since the end of the Cold War, a turning point for many European health systems, with most post-communist transition countries privatizing their state-run health systems, and many Western European health systems experimenting with new public management and other market-oriented health reforms. Following three introductory, stage-setting chapters, the handbook offers country cases divided into seven regional sections, each of which begins with a short regional outlook chapter that highlights the region’s common characteristics and divergent paths taken by the separate countries, including comparative data on health system financing, healthcare access, and the political salience of health. Each regional section contains at least one detailed main case, followed by shorter treatments of the other countries in the region. Country chapters comprise an historical overview focusing on the country’s progression through a series of political regimes and the consequences of this history for the health system; an overview of the institutions and functioning of the contemporary health system; and a political narrative tracing the politics of health policy since 1989. This political narrative, the core of each country case, examines key health reforms in order to understand the political motivations and dynamics behind them and their impact on public opinion and political legitimacy. The handbook’s systematic structure makes it useful for country-specific, cross-national, and topical research and analysis.

scholarly journals Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Melanie Bourque ◽  
Jean-Simon Farrah
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Public Management ◽  
Health Care Services ◽  
New Public Management ◽  
Health Care Systems ◽  
Supply And Demand ◽  
Managed Competition ◽  
Care Systems

In 1990, Roemer came up with a very influential health system typology. From his vast study, emerged three types of health care systems: nationalized, mandated and entrepreneurial. Health care systems are not static; slow changes and reforms somewhat alter values and goals on which those systems were initially established. It is fair to say, then, that over the last two decades, health care reformers have adopted a market-oriented governance model that blends new public management (NPM) and managed competition reforms in the provision of health care services to transform supply- and demand-side actors into “responsibilized” customers, payers or providers. These transformations beg the question as to whether we are witnessing a radical redefinition of health care systems through the implementation of market-oriented governance. We propose to add the evolution of market-oriented health reforms in five case studies to Milton Roemer’s typology of health systems. In light of our findings, we will wrap up the analysis with an assessment of the usefulness of Roemer’s classification for social scientists to grasp the evolution of health systems over the past 20 years, and more importantly, to analyze the current state of these health care systems after years of market-oriented reforms.

scholarly journals The Political Legitimacy of the Healthcare System in Portugal: Insights from the European Social Survey

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 202
Author(s):  
Maria Asensio
Keyword(s):  
Health System ◽  
Economic Crisis ◽  
Social Groups ◽  
Political Legitimacy ◽  
Negative Attitude ◽  
European Social Survey ◽  
The Political ◽  
Social Survey ◽  
Private Households ◽  
The Government

This article investigates the political legitimacy of the health care system and the effects of austerity on the population’s welfare, paying particular attention to Portugal, a country severely harmed by the economic crisis. Based on analysis of data collected from the European Social Survey on 14,988 individuals living in private households during the years between 2002 and 2018, the findings of this study aim to analyze the social and political perception of citizens on the state of health services in two distinctive periods—before and after the economic crisis, according to self-interest, ideological preferences, and institutional setup as predictors of the satisfaction with the health system. The results demonstrate a negative attitude towards the health system over the years, a consistent drop during the financial crisis period, and a rapid recovery afterward. The research also shows that healthcare evaluations depend on the perceived institutional effectiveness in the citizenry’s eyes. The more the citizens perceive the government as effective and trust-worthy, the more they are satisfied with the health system. Also, differences in healthcare evaluations among social groups were felt unequally: while vulnerable citizens were more affected by the Government’s plan of austerity measures for health reform, healthcare evaluations of better-off social groups—younger individuals, those with higher incomes, higher education, and better health status—did not decline. This study contributes to the academic debate on the effects of austerity on the population’s welfare attitudes and highlights the need to examine the different impacts of reforms introduced by the crisis on social groups.

scholarly journals 16.F. Workshop: Expanding coverage and improving quality: health reforms and policy learning across North America

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
North America ◽  
Health System ◽  
Health Systems ◽  
North American ◽  
Health Sector ◽  
Full Length ◽  
Policy Learning ◽  
Health Reforms ◽  
Health Sector Reforms

Abstract Health systems globally share challenges with expanding coverage while increasing quality. This workshop organized by the North American Observatory on Health Systems and Policies (NAO) will draw on the results of major health system studies of Canada, the United States (US) and Mexico. The NAO is a partnership of researchers, governments, and health organizations in the three countries, promoting evidence-informed health system policy decision-making. It works with the European Observatory on Health Systems and Policies and other global affiliates. One of the NAO's activities is co-publishing, with the European Observatory and the University of Toronto Press, full-length books about the health care systems in each of the three countries, modeled after the European Observatory's Health System in Transition (HiT) book series that includes full-length treatments of the systems in 70 countries. In 2020 new books will be jointly released in all three countries (Canada's third edition, the US's second, and Mexico's first). This workshop has two overarching Objectives first, to describe the recent health policy developments to provide insights into the successes and challenges of the three North American countries' health systems; second, to explore the potential for policy learning across the three countries with shared challenges but quite different institutional, political and economic contexts. Lead authors of each of these studies will deliver a short presentation describing the major public health and health system challenges faced in their country, and providing an analysis of recent health sector reforms. A panel discussion will follow, facilitated by the chairperson, that will start with a speaker that brings an international perspective to comment on the areas of convergence and divergence in health sector reforms in North America with those taking place across the European region. Each of the lead authors will then respond to the questions and comments raised, and will take questions and comments from the participants. This workshop brings together leading health system and public health scholars from Canada, the US, and Mexico for the first time at this international conference, which will provide participants with an opportunity to learn about these complex and ever-changing health systems and to engage in rich and lively discussion. Key messages In-depth health system studies provide the opportunity to identify lessons that may be transferable across national boundaries. Comparing recent health reforms in the three largest North American countries provide insight into policy learning across high- and middle- income contexts.

Political Steering and Bureaucratic Autonomy

2018 ◽  
Author(s):  
Morten Egeberg ◽  
Jarle Trondal
Keyword(s):  
Public Management ◽  
New Public Management ◽  
Organizational Capacity ◽  
The Political ◽  
Questionnaire Data ◽  
Public Governance ◽  
Bureaucratic Autonomy ◽  
Large N ◽  
New Public ◽  
Political Steering

This chapter draws attention to the effects of vertical specialization of organizations and how it affects public governance. The chapter documents that agency officials pay significantly less attention to signals from executive politicians than their counterparts within ministerial (cabinet-level) departments. This finding also holds when controlling for variation in tasks, the political salience of issue areas, and officials’ rank. In addition, it is documented that the greater the organizational capacity available within the respective ministerial departments, the more agency personnel tend to assign weight to signals from the political leadership. Expert concerns are strongly emphasized at both levels; however, agency personnel are more sensitive to the influence of affected parties. The chapter applies large-N questionnaire data at four points in time (1986, 1996, 2006, and 2016) that spans three decades and shifting administrative doctrines: New Public Management as well as post-New Public Management.

scholarly journals Exploring the role of gender and women in the political economy of health in armed conflict: a narrative review

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Kristen Meagher ◽  
Bothaina Attal ◽  
Preeti Patel
Keyword(s):  
Political Economy ◽  
Health Systems ◽  
Armed Conflict ◽  
Narrative Review ◽  
Health Systems Strengthening ◽  
The Political ◽  
Systems Research ◽  
Political Economy Of Health ◽  
And Gender

Abstract Background The ripple effects of protracted armed conflicts include: significant gender-specific barriers to accessing essential services such as health, education, water and sanitation and broader macroeconomic challenges such as increased poverty rates, higher debt burdens, and deteriorating employment prospects. These factors influence the wider social and political determinants of health for women and a gendered analysis of the political economy of health in conflict may support strengthening health systems during conflict. This will in turn lead to equality and equity across not only health, but broader sectors and systems, that contribute to sustainable peace building. Methods The methodology employed is a multidisciplinary narrative review of the published and grey literature on women and gender in the political economy of health in conflict. Results The existing literature that contributes to the emerging area on the political economy of health in conflict has overlooked gender and specifically the role of women as a critical component. Gender analysis is incorporated into existing post-conflict health systems research, but this does not extend to countries actively affected by armed conflict and humanitarian crises. The analysis also tends to ignore the socially constructed patriarchal systems, power relations and gender norms that often lead to vastly different health system needs, experiences and health outcomes. Conclusions Detailed case studies on the gendered political economy of health in countries impacted by complex protracted conflict will support efforts to improve health equity and understanding of gender relations that support health systems strengthening.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals 22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
The State ◽  
Lessons Learned ◽  
Three Dimensions ◽  
Health System Strengthening ◽  
New Work ◽  
State Of Health ◽  
The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

scholarly journals How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links

2021 ◽  
Vol 18 (8) ◽  
pp. 3860
Author(s):  
Katarzyna Krot ◽  
Iga Rudawska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health System ◽  
Health Systems ◽  
Quantitative Research ◽  
Public Trust ◽  
Complex Problem ◽  
Health Care Consumption ◽  
Mediating Role ◽  
Countries In Transition

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

Commentary on Chaplain-Physician Interactions From the Chaplain’s Perspective: A Mixed Method Analysis

2021 ◽  
pp. 104990912110030
Author(s):  
Rev George Handzo ◽  
Rev Brian Hughes
Keyword(s):  
Best Practices ◽  
Health System ◽  
Patient Care ◽  
Health Systems ◽  
Mixed Method ◽  
Effective Strategies ◽  
Optimal Patient Care ◽  
Relationship Of ◽  
The Relationship ◽  
Method Analysis

Gomez and her colleagues have presented a helpful study of the relationship of the chaplains in her health system to physicians which highlights several barriers to a well-integrated relationship and thus to more optimal patient care. We have seen these same barriers as we have consulted with health systems nationally and have also identified many best practices that mediate or even eliminate many of these barriers. This commentary describes some of what we have seen as chaplain-generated causes of those barriers and effective strategies that have been employed to overcome them. We also provide some resources for chaplains who wish to institute some of these best practices themselves.

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