The Privatization of Health Care in Europe: An Eight-Country Analysis

Abstract

This article presents an analysis of recent changes in the public-private mix in health care in eight European countries. The leading question is to what extent a process of privatization in health care can be observed. The framework for the analysis of privatization draws on the idea that there are multiple public/private boundaries in health care. The overall picture that emerges from our analysis is diverse, but there is evidence that health care in Europe has become somewhat more private. The growth of the public fraction in health care spending has come to an end since the 1980s, and in a few countries the private fraction even increased substantially. We also found some evidence for a shift from public to private in health care provision. Furthermore, there are signs of privatization in health care management and operations, as well as investments. Specific attention is spent on the identification of factors that push privatization forward and factors that work as a barrier to privatization.

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

“…In France as in Europe, health care is an increasingly privatized sector (Maarse, 2006;André and Hermann, 2009;Angeli and Maarse, 2012;André, 2015). This trend is not in contradiction to the role of the State in health care systems and the reinforcement of this role in numerous countries, particularly in France.…”

Path Dependency and the Politics of Socialized Health Care

“…It is important to acknowledge that in recent years some cross-national analyses have emerged (Jensen 2011;Jordan 2011;Kikuzawa, Olafsdottir, and Pescosolido 2008;Maarse 2006;Montanari and Nelson 2014;Wilensky 2002). A few analyze dependent variables that are similar to or related to the public share: public medical insurance coverage, per capita public health spending, or public health spending as a percent of GDP (Navarro 1989;Navarro et al 2006;Navarro and Shi 2001;Reeves et al 2014).…”

“…We conceptualize the public share as one meaningful indicator of the "socialization" of health care, public investments in health and health care, and the extent to which the state covers health care costs. The public share reflects policy differences in the organization of health care (Maarse 2006), and is one, while certainly not the only, key manifestation of the underlying differences in institutional regimes (e.g., national health services vs. national insurance systems) (Beckfield, Olafsdottir, and Sosnaud 2013;Wendt 2009). The size of the public share influences health care costs, shapes the organization of insurance, and affects how costs and risks are distributed across the population (Anderson et al 2003;Jordan 2011;Laugesen and Glied 2011;Morgan and Campbell 2011;Reinhardt, Hussey, and Anderson 2004;Tuohy, Flood, and Stabile 2004;Wilkerson 2003;Wilsford 1995).…”

Privatização da gestão do sistema municipal de saúde por meio de Organizações Sociais na cidade de São Paulo, Brasil: caracterização e análise da regulação

“…Convém situar as OS em relação a outras formas de participação do privado na saúde. Para tanto, recorre-se à tipologia de Maarse, segundo o qual se observam quatro formas de privatização no setor: da gestão, do financiamento, da provisão e do investimento 6 . Nesse sentido, se a privatização da gestão representada pelas OS pouco avançou nas duas primeiras décadas do SUS, o mesmo não se pode dizer de outros dois potentes processos não relacionados à reforma liberal de 1995, mas igualmente incentivados por políticas públicas.…”