The financial and economic crisis has had a visible but varied impact on many health systems in Europe, eliciting a wide range of responses from governments faced with increased financial and other pressures. This book maps health system responses by country, providing a detailed analysis of policy changes in nine countries and shorter overviews of policy responses in 47 countries. It draws on a large study involving over one hundred health system experts and academic researchers across Europe.

Focusing on policy responses in three areas – public funding of the health system, health coverage and health service planning, purchasing and delivery – this book gives policymakers, researchers and others valuable, systematic information about national contexts of particular interest to them, ranging from countries operating under the fiscal and structural conditions of international bailout agreements to those that, while less severely affected by the crisis, still have had to operate in a climate of diminished public sector spending since 2008.

Along with a companion volume that analyses the impact of the crisis across countries, this book is part of a wider initiative to monitor the effects of the crisis on health systems and health, to identify those policies most likely to sustain the performance of health systems facing fiscal pressure and to gain insight into the political economy of implementing reforms in a crisis.

Contents

• List of abbreviations
• List of contributors
• Acknowledgements
• Preface
• I. Country case studies
  • 1. The impact of the crisis on the health system and health in Belgium
    Irina Cleemput, Joeri Guillaume, Carine Van de Voorde, and Anna Maresso.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • References
  • 2. The impact of the crisis on the health system and health in Estonia
    Triin Habicht and Tamás Evetovits.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • Appendix 2.1
    • Acknowledgements
    • References
  • 3. The impact of the crisis on the health system and health in France
    Matthias Brunn, Karen Berg Brigham, Karine Chevreul, and Cristina Hernández-Quevedo.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • References
  • 4. The impact of the crisis on the health system and health in Greece
    Charalampos Economou, Daphne Kaitelidou, Alexander Kentikelenis, Anna Maresso, and Aris Sissouras.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • Appendix 4.1
    • Acknowledgements
    • References
  • 5. The impact of the crisis on the health system and health in Ireland
    Anne Nolan, Sarah Barry, Sara Burke, and Stephen Thomas.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • Appendix 5.1
    • Acknowledgement
    • References
  • 6. The impact of the crisis on the health system and health in Latvia
    Maris Taube, Uldis Mitenbergs, and Anna Sagan.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • Appendix 6.1
    • References
  • 7. The impact of the crisis on the health system and health in Lithuania
    Gintaras Kacevičius and Marina Karanikolos.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • Appendix 7.1
    • References
  • 8. The impact of the crisis on the health system and health in the Netherlands
    Ronald Batenburg, Madelon Kroneman, and Anna Sagan.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses
    • 4. Implications for health system performance
    • 5. Discussion
    • 6. Conclusions
    • References
  • 9. The impact of the crisis on the health system and health in Portugal
    Constantino Sakellarides, Luis Castelo-Branco, Patrícia Barbosa, and Helda Azevedo.
    • Introduction
    • 1. The nature and magnitude of the financial and economic crisis
    • 2. Health system pressures prior to the crisis
    • 3. Health system responses to the crisis
    • 4. Implications for health system performance and health
    • 5. Discussion
    • 6. Conclusions
    • Appendix 9.1
    • Acknowledgements
    • References
• II. Country profiles of health system responses to the crisis
  • Albania
    Genc Burazeri and Enver Roshi.
    • Economic trends
    • Policy responses
  • Armenia
    Lyudmila Niazyan and Varduhi Petrosyan.
    • Economic trends
    • Policy responses
  • Austria
    Thomas Czypionka and Maria M. Hofmarcher.
    • Economic trends
    • Policy responses
  • Azerbaijan
    Fuad Ibrahimov.
    • Economic trends
    • Policy responses
  • Belarus
    Aleksander Grakovich and Irina Novik.
    • Economic trends
    • Policy responses
  • Belgium
    Irina Cleemput and Carine Van de Voorde.
    • Economic trends
    • Policy responses
  • Bosnia and Herzegovina
    Milka Dancevic-Gojkovic.
    • Economic trends
    • Policy responses
  • Bulgaria
    Antoniya Dimova and Mina Popova.
    • Economic trends
    • Policy responses
  • Croatia
    Martina Bogut.
    • Economic trends
    • Policy responses
  • Cyprus
    Elisavet Constantinou and Mamas Theodorou.
    • Economic trends
    • Policy responses
  • Czech Republic
    Tomáš Roubal and Jan Šturma.
    • Economic trends
    • Policy responses
  • Denmark
    Andreas Rudkjøbing and Karsten Vrangbæk.
    • Economic trends
    • Policy responses
  • Estonia
    Triin Habicht and Mall Leinsalu.
    • Economic trends
    • Policy responses
  • Finland
    Jan Klavus and Lauri Vuorenkoski.
    • Economic trends
    • Policy responses
  • France
    Karine Chevreul, Karen Berg Brigham, and Sandra Mounier-Jack.
    • Economic trends
    • Policy responses
  • Georgia
    Tata Chanturidze.
    • Economic trends
    • Policy responses
  • Germany
    Klaus-Dirk Henke and Wilm Quentin.
    • Economic trends
    • Policy responses
  • Greece
    Charalampos Economou and Daphne Kaitelidou.
    • Economic trends
    • Policy responses
  • Hungary
    Csaba Dózsa and Szabolcs Szigeti.
    • Economic trends
    • Policy responses
  • Iceland
    Sigrún Gunnarsdóttir and Thorbjörn Jónsson.
    • Economic trends
    • Policy responses
  • Ireland
    Anne Nolan and Steve Thomas.
    • Economic trends
    • Policy responses
  • Israel
    Bruce Rosen and Amir Shmueli.
    • Economic trends
    • Policy responses
  • Italy
    Francesca Ferrè and Walter Ricciardi.
    • Economic trends
    • Policy responses
  • Kazakhstan
    Ninel Kadyrova and Tata Chanturidze.
    • Economic trends
    • Policy responses
  • Kyrgyzstan
    Baktygul Akkazieva.
    • Economic trends
    • Policy responses
  • Latvia
    Uldis Mitenbergs and Maris Taube.
    • Economic trends
    • Policy responses
  • Lithuania
    Gintaras Kacevičius and Skirmante Sauliune.
    • Economic trends
    • Policy responses
  • The former Yugoslav Republic of Macedonia
    Fimka Tozija.
    • Economic trends
    • Policy responses
  • Malta
    Natasha Azzopardi Muscat.
    • Economic trends
    • Policy responses
  • The Republic of Moldova
    Valeriu Sava.
    • Economic trends
    • Policy responses
  • Montenegro
    Ratka Knežević.
    • Economic trends
    • Policy responses
  • The Netherlands
    Ronald Batenburg and Paul Poortvliet.
    • Economic trends
    • Policy responses
  • Norway
    Anne Karin Lindahl and Jon Magnussen.
    • Economic trends
    • Policy responses
  • Poland
    Adam Kozierkiewicz and Christoph Sowada.
    • Economic trends
    • Policy responses
  • Portugal
    Leonor Bacelar-Nicolau, Patrícia Barbosa, and Constantino Sakellarides.
    • Economic trends
    • Policy responses
  • Romania
    Adriana Galan and Victor Olsavszky.
    • Economic trends
    • Policy responses
  • The Russian Federation
    Elena Potapchik.
    • Economic trends
    • Policy responses
  • Serbia
    Vukasin Radulovic.
    • Economic trends
    • Policy responses
  • Slovakia
    Karol Morvay and Tomáš Szalay.
    • Economic trends
    • Policy responses
  • Slovenia
    Tit Albreht, Eva Turk, and Valentina Prevolnik-Rupel.
    • Economic trends
    • Policy responses
  • Spain
    Enrique Bernal-Delgado, Sandra García-Armesto, and José Ramón Repullo.
    • Economic trends
    • Policy responses
  • Sweden
    Anders Anell and Fredrik Lennartsson.
    • Economic trends
    • Policy responses
  • Switzerland
    Alberto Holly and Philippe Lehmann.
    • Economic trends
    • Policy responses
  • Tajikistan
    Ghafur Khodjamurodov.
    • Economic trends
    • Policy responses
  • Turkey
    Salih Mollahaliloglu and Mehtap Tatar.
    • Economic trends
    • Policy responses
  • Ukraine
    Valeria Lekhan and Mariia Telishevska.
    • Economic trends
    • Policy responses
  • United Kingdom
    John Appleby, Seán Boyle, Pat McGregor, Ciaran O'Neill, Shelley Farrar, David Steel, Marcus Longley, and Ceri Philips.
    • Economic trends
    • Policy responses

Figure

The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues.

The Observatory is a partnership hosted by the WHO Regional Office for Europe; which includes the Governments of Austria, Belgium, Finland, Ireland, Norway, Slovenia, Sweden, the United Kingdom, and the Veneto Region of Italy; the European Commission; the World Bank; UNCAM (French National Union of Health Insurance Funds); the London School of Economics and Political Science; and the London School of Hygiene & Tropical Medicine. The Observatory has a secretariat in Brussels and it has hubs in London (at LSE and LSHTM) and at the Technical University of Berlin.

This is one part of a study on the impact of the crisis on health and health systems in Europe prepared jointly by the WHO Regional Office for Europe and the European Observatory on Health Systems and Policies. It provides an overview of health system responses to the crisis by country and case studies of the impact of the crisis in selected countries.

For an analysis of the impact of the crisis across countries, see:

Thomson S, Figueras J, Evetovits T, Jowett M, Mladovsky P, Maresso A, Cylus J, Karanikolos M and Kluge H (2014). Economic crisis, health systems and health in Europe: impact and implications for policy. Maidenhead: Open University Press.

For a summary of the whole study, see:

Thomson S, Figueras J, Evetovits T, Jowett M, Mladovsky P, Maresso A, Cylus J, Karanikolos M and Kluge H (2014). Economic crisis, health systems and health in Europe: impact and implications for policy. Copenhagen: WHO Regional Office for Europe/European Observatory on Health Systems and Policies (Policy Summary 12).

The study is part of a wider initiative to monitor the effects of the crisis on health systems and health. Those interested in ongoing analysis will find updates through the Health and Crisis Monitor of the European Observatory on Health Systems and Policies in collaboration with the Andalusian School of Public Health (www.hfcm.eu), and the website of the Division of Health Systems and Public Health at the WHO Regional Office for Europe (www.euro.who.int/en/health-topics/Health-systems).

Box

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