Economic crisis and inequalities in health systems in the countries of Southern Europe.

Mauro Serapioni

doi:10.1590/0102-311x00170116

Abstract

The current article addresses the issue of health system inequalities in the countries of Southern Europe, specifically Spain, Greece, Italy, and Portugal. The study resulted from a non-systematic literature review, based on the scoping review proposal. We begin by presenting a brief contextualization of the social welfare state systems in these European countries, highlighting the principal specificities and differences in relation to other European welfare state systems. Next, we describe the health systems in the four countries, emphasizing the respective reform processes and the main health inequalities that have characterized them before and during the economic crisis. The crisis and austerity policies have greatly increased the level of dissatisfaction with healthcare provision in these countries, particularly in Greece and Portugal. In this sense, we conduct a comparative discussion of the health inequalities, identifying both common trends and differences. In the four countries, the social gradient (particularly in education, income, and labor) represents the principal determinant of health inequalities, while not ruling out geographic inequalities in access to health services as the result of different levels of economic development in the various regions. Finally, we discuss the recent debate in the international literature on the relationship between different welfare state systems and health inequalities, and precisely the critique of the use of welfare state typologies as a determinant of health and health inequalities.

Highlights

Despite the overall increase in living standards in the 20th century and the introduction of universal health systems, many studies have identified persistent inequalities in all the industrialized countries
In the countries of Southern Europe, Spain, Greece, Italy, and Portugal, the reforms of the 1970s and 1980s introduced universal national health services and the concern for reducing geographic imbalances between different regions, social inequalities in health only became a critical issue in the late 1990s
The article aimed to describe the paths taken by health systems reforms in Spain, Greece, Italy, and Portugal and analyze the main forms of health inequalities identified in these countries before and during the economic crisis of 2008, based on a systematic literature review

Summary

Introduction

Despite the overall increase in living standards in the 20th century and the introduction of universal health systems, many studies have identified persistent inequalities in all the industrialized countries. 135), while pointing to the central role of economic, social, environmental, and institutional determinants in the production and development of health inequalities 4 In this sense, social inequalities in health are still a critical issue for the majority of European countries, as evidenced by the British study Fair Society, Healthy Lives. In the countries of Southern Europe, Spain, Greece, Italy, and Portugal, the reforms of the 1970s and 1980s introduced universal national health services and the concern for reducing geographic imbalances between different regions, social inequalities in health only became a critical issue in the late 1990s. Various studies have identified the impact of the economic crisis on the most vulnerable population groups, with increasing rates of mental health disorders (e.g., anxiety and depression) and a rise in suicides 8,10 Such effects have already been observed in Greece, Spain, Ireland, Italy, and Portugal 11,12. The author argued that the welfare state in Southern Europe is a variant of the Conservative type of regime 16

ECONOMIC CRISIS AND INEQUALITIES IN HEALTH SYSTEMS

Findings

Discussion

Conclusion