Policies and politics of the health reforms in southern European countries: A sociological critique

Abstract

The politics of health reform in the southern European countries are mixed with the interests of the pressure groups. Among these, the most important ones are the medical profession in the case of non-democratic countries (such as Portugal before 1974) and the programs of the political parties (as in Italy between 1964 and 1975). In the last decade southern European countries have developed health reform processes that have been substantially changed by the different pressure groups. We will begin with a theoretical framework on the relationship between socio-economic development and health reform. In the second part we study two cases: Portugal (1961–1974) and Italy (1964–1975).

In the case of Portugal we analyze the influence of the medical profession on health planning and social reform before 1974. In contrast to other southern European countries the Portuguese medical profession has been one of the most important factors advocating health reform in the country; it has been a basic proponent of change towards a global health reform in the '60s. The reasons are various: the relationships of the medical profession with the regimes of Salazar and Caetano; the poor economic situation of most of the physicians; the criticism of the Ordem dos Médicos; and the influence of specific medical leaders (such as Miller Guerra or Gonçalves Ferreira). The lack of political parties before the revolution, allowed both the medical association and the medical leaders to have a considerable importance as health pressure groups. This has decreased with the creation of political parties and the participation of the people in the organization of health structures.

In Italy, the design of a health reform (the riforma sanitaria) has been an important task of the political parties since 1964, and specially of the Christian Democrats, the Socialist and Communist Parties; other important groups have been: trade unions, medical profession, and other pressure groups. All these health reforms have crystallized in the project of the Servizio Sanitario Nazionale, its main goal being the linkage of local health units and regional hospitals. The most important contributions are those of the health leaders of the political parties: Bruni (from the DC), Seppilli (PSI), and Berlinguer (PCI). We analyze the relationship between the ideological stands of the Italian parties and their health reform models. Most of the parties, and other interest groups, recognize the same problems, namely: the regionalization of services, the expansion of preventive medicine, the role of the private physician, the power of the pharmaceutical industry, the cost of the health reform, the democratization and control of the Servizio Sanitario Nazionale, and the timing of its implementation. These problems are also common to Portugal, Spain, Greece and Yugoslavia, although the lack of competitive political parties in some of these countries leaves the health modeling in the hands of the Government and private institutions, with supposed fewer alternatives for a health reform.