Implementing health care reforms in Europe: policies, actors and institutions

Abstract

European health care systems have embarked programmes of radical reform intended both to contain costs, maintain quality and promote equity. In most countries, the instruments used and the declared objectives seem to be similar and derived from the American model. As a result, observers are tempted to infer that these health systems are converging towards a single liberal model.

In an attempt to qualify this view, the present article will seek to show that the reforms currently in progress must be evaluated not in terms of universal criteria but by reference to the historical contexts in which they are being implemented.

Thus, for example, the British and French reforms are running into difficulties that are often attributed to "resistance". It is shown here that these difficulties are due to the fact that the advocates of the reforms underestimated the influence of earlier dynamics and the importance of the implementation phases. To what extent lessons for Japan health care reform can be drawn from European experiences is an open issue.