The marketisation of health care in Europe

Abstract

In contrast to the United States and other parts of the world, the financing and provision of health care in Europe is still very much based on public planning and the services are mostly delivered by public organisations, or private organisations that are not aiming to maximise profits. Surveys show continuously strong support for this system. With few exceptions citizens are rather critical of privatisation and marketisation in healthcare provision, and they have good reasons to be. The public system not only ensures that the vast majority of citizens have access to health care, but comparisons with the US also show that the public provision of health care is cheaper than in private for-profit systems. However, despite the obvious superiority of public healthcare systems, the public nature of healthcare provision in Europe has been challenged through a series of reforms that amount to what can best be described as the marketisation of health care in Europe. Such developments include the introduction of purchaser-provider relationships, the establishment of internal markets, competition between different providers, performance-oriented compensation, individualisation of risks, outsourcing, the use of private public partnerships, and the sale of public hospitals to private investors. While these reforms have officially been introduced to cut costs and improve efficiency, they have primarily served to create healthcare markets which promote inequality among patients and healthcare workers and erode the public nature of healthcare provision.