Health Systems and Inequalities in the Southern European Countries

Despite the general increase in the standards of living during the twentieth century and the introduction of universal healthcare systems, many studies have pointed out the persistence of inequalities in all industrialized countries. Also in Southern European countries (SEC), despite the creation of universal national health services during the 1970s and 1980s and the concern to reduce geographical and social health inequalities, the equity issue only became a priority in the late 1990s. Therefore, it is important to explore the potential of iniquity, induced by health systems, which is being produced by health reform processes both at national and regional level, before and during the current financial crisis. Considering this framework, new institutional arrangements were introduced in health systems and new articulations between public and private sector within services provision were made, which will be analysed. Another way of inducing inequalities is to increase the involvement of users in the health spending through co-payments and users’ fees. This is a common practice registered in SEC, which is not only erecting financial barriers to access health system as it is contributing to renew health inequalities. Another trend to be explored in the presentation refers to the progressive increasing of private health expenditure when compared to the total expenditure in all SEC (despite the recognition of the right to health and access to health services). The structure of this presentation will start with a brief contextualization of the Greek, Spanish, Italian and Portuguese health systems, then the main health inequalities affecting population and the role of the health systems in the production of such inequalities will be described through the identification of the potential of inequity induced by the current financial crises.