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.
