Abstract
This paper assesses recent health sector reform strategies across Europe adopted since the onset of the 2008 financial crisis. It begins with a brief overview of the continued economic pressure on public funding for health care services, particularly in tax-funded Northern European health care systems. While economic growth rates across Europe have risen a bit in the last year, they remain below the level necessary to provide the needed expansion of public health sector revenues. This continued public revenue shortage has become the central challenge that policymakers in these health systems confront, and increasingly constrains their potential range of policy options. The paper then examines the types of targeted reforms that various European governments have introduced in response to this increased fiscal stringency. Particularly in tax-funded health systems, these efforts have been focused on two types of changes on the production side of their health systems: consolidating and/or centralizing administrative authority over public hospitals, and revamping secondary and primary health services as well as social services to reduce the volume, cost and less-than-optimal outcomes of existing public elderly care programs. While revamping elderly care services also was pursued in the social health insurance (SHI) system in the Netherlands, both the Dutch and the German health systems also made important changes on the financing side of their health systems. Both types of targeted reforms are illustrated through short country case studies. Each of these country assessments flags up new mechanisms that have been introduced and which potentially could be reshaped and applied in other national health sector contexts. Reflecting the tax-funded structure of the Canadian health system, the preponderance of cases discussed focus on tax-funded countries (Norway, Denmark, Sweden, Finland, England, Ireland), with additional brief assessments of recent changes in the SHI-funded health systems in the Netherlands and Germany. The paper concludes that post-2008 European reforms have helped stretch existing public funds more effectively, but seem unlikely to resolve the core problem of inadequate overall public funding, particularly in tax-based health systems. This observation suggests that ongoing Canadian efforts to consolidate and better integrate its health care providers, while important, may not eliminate long-term health sector-funding dilemmas.
Highlights
This article explores two important elements of the health policy-making environment in Northern Europe in the aftermath of the 2008 financial crisis
The onset of the 2008 financial crisis signaled a fundamental shift in the economic foundation of European health care systems
The most recent gross domestic product (GDP) projections for 2017 (Figure 1) show that even the best performing European countries – such as Germany at 1.6% – remain below the 2% per year economic growth rate that economists consider the bare minimum for a sustainable economic expansion
Summary
This article explores two important elements of the health policy-making environment in Northern Europe in the aftermath of the 2008 financial crisis. In tax-funded health systems, these reforms have focused, first, on re-structuring public sector administrative arrangements for health providers, public hospitals, and, second, on both streamlining the delivery of, and reducing the volume of demands for, health system services from elderly patients. Through these combined structural efforts, these health systems have sought to respond to the constrained post-2008 fiscal environment with multiple efforts to improve the cost efficiency of public service management and delivery. The article concludes with several parallels to recent and current decisionmaking strategies in several of the Canadian provinces
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