Understanding Changes in Health Systems, a Patient-Centered Perspective

The recent financial crisis has compelled governments in Southern Europe and Eastern Europe to attempt austerity driven reforms. While formal changes in health care were rarely attempted, access to health care and health care utilization appear to have declined. This leaves us with an important gap in our understanding of health systems and the manner in which they change. A new approach is suggested, based on patient access to health care, in order to better capture and understand these changes. The main aim of this paper is to build a new measure to asess changes in health systems, that can capture the direct impact that these systems have on patients. Welfare scholars have long acknowledged the faults with utilizing expenditure data (Esping-Andersen, 1990), yet alternative measures such as replacement rates are not useful for studying health policy. The measure put forward here builds and extends on Bambra’s (2005) decommodification measure of health care systems. Health systems are classified in terms of how financing, provision and regulation affects individuals’ reliance on the market for their health needs. Weighed share of private expenditure, share of private hospital beds, as well as measures of coverage and utilization are used to make up the new index. The dual advantage of this conceptualization is that it can closely follow changes in health systems that might not be visible when looking at formal legislative acts, while also assessing these changes in a manner that is most relevant for those most affected by them: disadvantaged groups. This new measure is used to compare recent changes in Spain, Greece, Portugal, Hungary, Slovenia and Latvia. These countries were chosen as they represent the two regions of the European Union most affected by the financial crisis. The paper will compare changes in decommodification with actual legislative changes over a 5 year period before and after the financial crisis. By contrasting the two, discrepancies are shown between formal understandings of health system changes and actual changes that matter for patients. Process tracing is used to understand these changes. References: Bambra, C. (2005). Cash Versus Services: “Worlds of Welfare” and the Decommodification of Cash Benefits and Health Care Services. Journal of Social Policy, 34(2), 195–213. Esping-Andersen, G. (1993). The three worlds of welfare capitalism. Cambridge, UK: Polity Press.