Social Citizenship Decline and System Convergence: How Does Health Care Fare?

Abstract

During recent decades predictions of retrenchment and convergence of social policies have been legion, both in terms of expenditure and institutional set-up. Structural pressures such as trans-nationalization of capital, budgetary and financial restrictions in the European Union, negative demographic development and high unemployment levels are held to severely limit the possibilities to maintain, or develop, social policies. Recent research has focused on changes in cash benefits. Comparative analyses of changes in services, the other pillar of social policy, have so far been limited to a few countries. The purpose of this paper is to perform a diachronical cross-national analysis of health care services, comparing their development to that of cash benefits. Based on theories of social citizenship development, we propose a framework for the comparative study of health care systems focusing on organization structures rather than levels of expenditure. Contrary to previous claims we find that European health care systems are not particularly hit by retrenchment and that convergence is absent in key health care dimensions, namely coverage and provision. We only find convergence in the sense of increasing shares of private health care financing. The examination is based on OECD Health Data, SCIP and SaMip, providing both a descriptive analysis and multi-level regressions.