The Politics of Health Care

The Politics of Health Care

If an avian flu pandemic were to strike Europe, who would set the policy for quarantines, vaccine distribution, treatment protocols, and the like? The European Union? Individual nations? An EU health committee? The short answer, says Scott Greer, an assistant professor of health management and policy and an expert in European health care policy, is that no one knows.

That’s because when it comes to health policy, Europe has no clear-cut, mutually agreed-on system of command. Through the European Court of Justice, the EU defines a set of regulations under which its 25 member states can formulate health policy. But each individual member state has its own autonomous health system, and the quality and character of those systems vary immensely. Moreover, within each of those national systems, at least three levels of government are at play—the EU itself, the federal government, and regional governments. If something like bird flu were to break out, local governments as well as organizations such as the World Health Organization would also weigh in.

Potentially it’s a recipe for chaos, says Greer, who is trying to track what’s happening in Europe today and to understand its significance. Having studied the intersection of politics and health for years, he’s certain of this: some of the world’s most intractable health problems are fundamentally political problems. Witness both Hurricane Katrina and the 2004 outbreak of SARS, he says, where recovery and response efforts were plagued by poor communication among various government agencies.

But it doesn’t take a disaster for problems to surface. Not long ago, a British woman who’d been put on a wait list for a hip replacement elected to have the surgery in France. When the British health system refused to pay for the operation, the woman sued. The European Court ruled that under the rules of internal market competition, Britain’s National Health System must pay. The court delivered the same ruling for a similar case in the Netherlands.

Greer, who has published a book about the health policies of the UK and is now at work on a comparative study of the health systems of the UK, Germany, France, and Spain, says it’s a challenge simply to track these fast-changing developments, let alone understand them.

His work is much needed, though. This summer, officials in the executive branch of Scotland asked Greer to provide training to the country’s health services and public health officials, so they’d have a better grasp of how the various layers of government—EU, national, regional, local—affect their ability to make policy. He’s doing similar work with the Royal College of Physicians of London, the UK Department of Health, and the British Medical Association.

Greer expects his research to be useful to other European nations, as well, and ultimately to shed light on health care in the United States. With the looming threat of an avian flu pandemic, his efforts couldn’t be more timely.

Photo by Peter Smith.

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