A Mediterranean paradigm? Convergence and divergence in the Southern European Health Care Systems

Guido Giarelli

doi:10.1590/interface.210116

Abstract

The concept of a ‘Mediterranean paradigm’ was raised by Josep Figueras in 1994 as a distinctive Southern European model for the health care systems of Italy, Spain and Greece based on the basis of six factors. The subsequent debate (including Portugal, too) is reconstructed on the basis of pros and cons arguments. The specific contribution of the author to the debate - consisting in the proposal of the concept of ‘health macro-region’ as an analytic tool to pursue a more comprehensive approach in comparative terms on the basis of a connectionist model - is then presented in details by showing the peculiar characteristics of the Southern European health macro-region. Finally, an historical perspective involving three different kinds of temporality (long, middle and short span) is proposed in order to explain both the substantial similar timing (diachronic convergence) and, at the same time, the significant differences (synchronic divergences) among Southern European health care systems in the way and levels their national health services were implemented.

Highlights

The article addresses in the first paragraph the concept of ‘Mediterranean paradigm’ by reconstructing its origin and the debate about it, and discussing the pros and cons arguments by various scholars
A wider perspective is proposed in the second paragraph by advancing the concept of ‘health macro-region’ as an analytic tool to pursue a more comprehensive approach on the basis of a connectionist model, presented first in comparative terms by applying it to the European health macro-regions, and showing in more details the peculiar characteristics of the Southern European health macro-region
The authors responded substantially positive to the question posed in the title of their article: by comparing the recent evolution of the health systems of Italy, Spain and Greece, they identified a series of similar traits and concluded stating that, as a whole, they composed the framework of what they called a real ‘Mediterranean paradigm’, inclusive of “a distinctive pattern of health and disease, a common historical evolution of National Health Services, shared principles, limited implementation, similar patterns of organization and delivery, and, in recent years, a common crisis and responses to it”[1] (p. 143)

Summary

Introduction

The article addresses in the first paragraph the concept of ‘Mediterranean paradigm’ by reconstructing its origin and the debate about it, and discussing the pros and cons arguments by various scholars.

Results

Conclusion