Salami Slicing a Role for Private Providers: The Carve-Up of Europe’s Health Services

Salami Slicing a Role for Private Providers: The Carve-Up of Europe’s Health Services

John Lister
DOI: 10.4018/978-1-4666-3982-9.ch008
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A distinctive model of privatisation is being rolled out in health care systems across Europe as the private sector seeks to recapture a larger share of the public and social health insurance budget for health care. The mechanism of this is “reforms” which break up centralised systems and scale down public provision, while opening up collective budgets for private providers. While such changes are being implemented at varying speeds in different countries, the restructuring since 1989 of a tax-funded health care system along market lines in England offers a case study of these “reforms” in action. The British coalition government elected in 2010 is pressing even faster for these changes in controversial new legislation.
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“Reforms” Which Cut Costs And Those That Increase Them

It is important to distinguish between spending cuts, which are occasionally loosely termed as “reforms,” and structural reforms. On the one hand severe outright cuts in spending are being imposed in a number of European countries (notably Ireland, Portugal, Spain and Greece) as a result of external constraints on public spending in the aftermath of the 2008 banking meltdown and the instability of national economies. Similar cuts, dressed up as “efficiency savings” are being pursued in England by the right wing coalition government with the target of cutting £20-£30 billion from spending by 2014.

Although the results of such cuts can be far-reaching and serious for those dependent on the services in the firing line, the structure and operation of the system remains largely intact. These measures are not new: as “the blunt instruments of budget constraint and cost shifting” (Tuohy, 1999, p. 4), such policies have a history reaching back at least to the 1970s, when global economic factors and the rise of neo-liberal ideology began to rein in the post-war expansion of welfare provision.

Their effect on health services varies according the scale of the cutback imposed, and whether this represents a real terms reduction in spending, or simply a restriction on the rate of increase: in many cases, as in England, where a decade of rapid real-terms expansion of health care spending has come to an abrupt and traumatic halt, to be followed by at least three years of real terms cuts, both factors apply.

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