The Challenge of Citizens' Participation in Southern European Health Systems

The purpose of this presentation is to analyze citizens’ participation (CP) in the health systems of Greece, Italy, Portugal and Spain, which will be framed under Southern European countries Welfare State “model”. Through a review of the existent sanitary regulations, health plans and published literature on CP in the health sector, citizen participatory practices will be analyzed. First, the main stages of the health reform processes will be described, so that we can take into account the context in which such experiences of participation in the health domain have been developed. Then, the preliminary results of the research on CP experiences in the health systems of the four countries will be presented. Some of the research results are noteworthy: a) citizens’ participation in the decision-making process on health has become the focus of attention of the public policies only after the 1990; b) there has been a significant progress in the regulatory framework and in the acknowledgement of users’ rights, particularly in Italy, Portugal and Spain; c) the development and implementation of participatory mechanisms were insufficient, discontinuous and limited to certain geographic regions; d) in Greece, despite the intentions to implement participatory practices within national health system, those do not exist until today; e) the scientific production and theoretical contribution of the South European Countries on the subject of public participation in the health sector still is insufficient. To conclude, some reflections on the possible developments of citizen’s participation within the health systems of the Southern European macro-region will be proposed.