Political Determinants of Health: Health Care Privatization and Population Health in Europe

Abstract

Abstract Context: The extent to which health care reforms affect health remains understudied. Health care reforms result in policy outputs that determine provision of medical services, which have consequences for the health of the population. The authors scrutinize this relationship between health policy outputs and population health by focusing on legislative changes implying privatization of health care delivery and finance. They ask the following question: What is the relationship between reforms that privatize health care provision and population health in terms of health outcomes and inequalities? Methods: They answer this question by relying on fixed-effects time-series cross-section models. The authors use an original dataset of health care reforms passed in 36 European countries from 1989 to 2019. Health outcomes are operationalized with measures of subjective health status, unmet health needs, and resulting health inequalities. Findings: Their results show that privatization of health care is associated with higher rates of bad subjective health and unmet health needs several years after the passing of reforms. These effects are stronger for individuals in the lower tiers of income and education, resulting in greater socioeconomic inequalities. Conclusions: The article contributes to conceptualization of the political determinants of health as health policy outputs and a better understanding of the relationship between policy outputs and population health outcomes.