Health care in post-crisis South Europe: Inequalities in access and reform trajectories

The European debt crisis stimulated debate about the future of national health systems. The objective of this article is to contribute to this debate by examining any changes in the scope and content of universal coverage and underlying pattern of solidarity in South Europe. Access to health care provides the vantage point for our analysis. Inequalities in access are scrutinized along a number of dimensions by using data from various sources. Our main conclusions clearly show that the public health care systems in Italy and, particularly, in Spain weathered the crisis pretty well and retained their universalistic features. Nonetheless, rising supplemental private coverage (of an "occupational-mutualist" type) adversely impacts access, but it is unclear how this will unfold in the near future. Tackling fragmentation through expansion and equalization of coverage, though for a comparatively "lean" basket of provisions, has been the focus of reforms in Portugal and Greece. This keeps private spending high and sustains inequalities, whereas any prospects for a stronger variant of universalism remain an open question.