HEALTHDOX: The Paradox of Health State Futures

The end of the cold war was a watershed for many European health systems, with most post-socialist transition countries privatizing their state-run health systems, and many Western and Southern European health systems experimenting with new public management and other market-oriented health reforms. The HEATHDOX project took stock of these developments by providing a thorough political analysis of the health reforms undertaken in 37 European countries since 1989. 


Despite the common problems of health systems coping with growing demands as populations age, medical technology advances, and populations move more freely across borders, Europe’s health systems have shown rather large differences in their abilities to cope with these problems. Some key differences concern the degree to which the public is divided amongst different competing health programs such as public or private health care, and the extent to which sufficient tax financing is available to assure universality of coverage and access, as well as the success with which politicians and health ministers have been able to generate consensus for new policies. These factors divide the national health systems characterized by an optimistic and sustainable future outlook from those that suffer from division, conflict and inadequate provision of health care services. 

Furthermore, by relying on natural experiments and panel data, the consortium has been able to demonstrate important causal impacts of health policies and health experiences on individual attitudes, including:

  • Individuals that opt-out of public programs and purchase private insurance become more politically conservative, and less supportive of government health care provision;
  • Waiting-time guarantees result in increased public satisfaction with the health system and support for government programs, even before waiting times have actually decreased, possibly indicating that citizens approve of governments’ recognition of their health care needs as a good in itself;
  • This ‘recognition effect’ wears off over time, however, unless service performance improvement is maintained;
  • Surprisingly, the positive effect of waiting-time guarantees on health care satisfaction is most pronounced among people in good health and with limited contact with health care rather than those with most contact with the health care system;
  • Austerity politics after the financial crisis resulted in greater levels of public satisfaction with the health system in some countries, depending upon partisanship and party framing;

Project links

Research Team

Prof. E.M. Immergut
European University Institute

Dr. M. Ainsaar
Tartu University

Prof. Dr. K.M. Anderson
Southampton University

Prof. M. Asensio
ISCTE – Instituto Universitário de Lisboa

Prof. DR. P. Blomqvist
Uppsala University

Prof. DR. C. Devitt
Trinity College Dublin

Prof. DR. M. Oskarson
University of Gothenburg