Book Review

Book Review: “Trends in EU Healthcare Systems”

Interview with the author Prof. Win De Gooijer (E-)Hospital interviewed Prof. DeGooijer on the main findings of hisbook:

What are the implications of the changing social context for healthcare systems in the EU?

The neo-liberal course that the international political economy has taken since the beginning of the 1980s has negatively influenced social cohesion in the countries of the European Union. Governments withdrawing from the economic process, leaving social developments increasingly to the market, have created a society with a growing gap between “haves” and “have nots”. This development has also affected the healthcare systems of the countries of the EU. Although these systems are based on the idea of solidarity among all citizens, the neoliberal course of the international political economy is slowly creating a “two classes medicine”.

Based on your findings, who do you believe decides on the production and consumption of healthcare goods and services?

In a democratic society where the production and consumption of goods and services are mainly a matter of private enterprise, governments have to tolerate, in principle, the produce of private initiatives. That also applies for the production and consumption of healthcare goods and services. However, governments can and do condition and correct, in this respect. As for healthcare, one can think of quality regulations, capacity limitations, educational conditions, and licensing. It is important to know however, that governments can never be completely absent in the process of the production and consumption of healthcare goods and services, because of constitutional obligations.

Do you believe there will one day be a universal EU healthcare system?

Healthcare systems of the EU countries are subject to the subsidiarity principle, which means that each member state is free to make its own arrangements. However, directives from Brussels have a spill-over effect as regards healthcare, which causes subsidiarity principle to slowly erode. That, surely, will not lead to a universal EU healthcare system, because cultural differences between member states are far too large.

Nevertheless, there are several aspects of healthcare, which do not affect the subsidiarity principle. Here, one can think of matters like technology assessment, clinical guidelines, and quality regulations. They could easily be transferred to Brussels. I believe this will happen.

Do you feel that EU countries have succeeded in achieving the threefold objectives of their reform methods, i.e., improving quality, containing costs, and maintaining equal access?

The answer is unrestrictedly negative. We don’t know if all the money which has been spent on quality improvement has led to better outcomes. Furthermore, we don’t live up to our promise of equal access, and cost containment measures have had an only temporary subduing effect. Healthcare has its own dynamics, which are very difficult to control in democracies.

In your opinion, how can hospital management contribute to the positive development of healthcare?

The primary objective for hospital managers always has been and should be to convince doctors that it is of utmost importance to pursue efficiency and effectiveness in healthcare delivery. After all, the bulk of healthcare is financed with public money. It is a moral and ethical obligation to spend that money responsibly.

In the short term, what will be the major changes in healthcare in the future?

In the framework of the present-day international political economy, one may expect a growing importance of the market for healthcare. Those who cannot play that market game will depend on an increasingly limited healthcare safety net provided by the government. Personally, I would favour a more social international political economy. There are some signs which point in such a direction. It is too early however to say that these are a prelude to major changes in the international political economy.

Win De Gooijer is a professor in the Department of Public Policy at Leiden University, the Netherlands, where he teaches a course on ‘Healthcare Systems in an International Perspective’. He has spent over 25 years in the healthcare industry, as General Manager of a psychiatric hospital, and as CEO of a foundation for care of the elderly. During his career in healthcare, he served on several governing and advisory boards in the Netherlands and the European Union.

Professor De Gooijer is the author of ‘Trends in EU Healthcare Systems’, a scholarly publication in which he likens the healthcare system to a pendulum that can be positioned and repositioned along a spectrum represented by a social solidarity model on the far left, and a market model on the far right. He advances compelling evidence that the pendulum has been moving further right since about 1980 and he views this trend as a cause for concern by all who believe that social solidarity should underpin entitlement to healthcare.