The welfare regime typology of the Danish sociologist Gøesta Esping-Andersen has become a modern social science classic and is widely used as a theoretical foundation for all kinds of research projects. However, his three-folded model differentiating regimes on the basis of welfare provision has also been challenged. Many studies have criticized Esping-Andersen for his non-acknowledgement of a Southern welfare regime including Greece, Spain, Portugal and Italy (...). Historic circumstances have produced fragmented welfare states which provide partly extensive state-led services, e.g. in health care, but have very limited benefits in other areas. The question remains whether “the peculiarities of these cases are variations within a distinct overall logic [or] a wholly different logic per se”, as Esping-Andersen (1999, p.90) has formulated it.
Claire Bamba (2005) has challenged Esping-Andersen’s welfare regime typology focusing on health care and identified two additional subcategories. Bamba argued that health care provision is a very distinguished feature of the welfare state and countries may follow a different logic in their health care services than they pursue in other branches of their welfare states (...).
This paper argues that Southern countries can be included in Esping-Andersen’s typology when looking at welfare areas independently and thus do not form an independent regime. The only clear difference they show is that their health care services and other areas of welfare state support follow different logics, which is also true for other countries such as the United Kingdom. Moreover, following Katrougalos (1996) it is argued that the distinctive features of Southern countries are based on the incompleteness of the development of their welfare states which have undergone considerable transformations in the last 30 years.
The paper is structured as follows: Adjoining this introduction, the second chapter outlines Esping-Andersen’s welfare typology, summarizes the most prominent criticisms and portraits the state of research on the Southern regime type. The third chapter gives overviews of the health care systems in Southern countries and compares them to see whether they really form a new welfare regime. The fourth chapter outlines Claire Bamba’s decommodification index for health care and compares it to data from Southern countries while chapter five summarizes the findings and draws up a conclusion.
Table of Contents
1. Introduction
2. The Welfare Regime Debate
2.1 Esping-Andersen’s Three Worlds of Welfare Capitalism
2.2 Criticism of Esping-Andersen
2.3 The Southern Regime Type
3. Health Care in Southern Countries
3.1 The Spanish Health Care System
3.2 The Portuguese Health Care System
3.3 The Italian Health Care System
3.4 The Greek Health Care System
4. A Southern Regime in Health Care?
5. Measuring Welfare Regimes in Health Care – Where do we group the Southern Countries?
5.1 Clare Bamba’s Decommodification Index for Health Care
5.2 Applying the Decommodification Index for Health Care to the Southern Welfare Regime
6. Conclusion
Research Objectives and Core Themes
This paper examines the validity of the "Southern welfare regime" concept by focusing specifically on health care provision in Spain, Portugal, Italy, and Greece. The research question addresses whether these nations constitute an independent welfare regime type or if their health care systems are better understood as evolving models characterized by specific developmental stages rather than an entirely different underlying logic.
- Theoretical evaluation of the Esping-Andersen welfare regime typology.
- Comparative analysis of health care systems in Southern European nations.
- Application of the decommodification index to Southern health care services.
- Discussion on the influence of historical context and path dependency on welfare state development.
- Critical assessment of standard welfare classification models in the context of health service provision.
Excerpt from the Publication
3.1 The Spanish Health Care System
The provision of health care in Spain is predominately a task of the public sector. This resulted from the Franco dictatorship which modernized and extended public health care services. A major step was the Basic Social Security Act of 1967. This law facilitated the transition from a means-tested disrupted insurance structure to a social security system covering most of the working population and their dependents. During the 1960s and 1970s, massive investments were made into the public health infrastructure. One central aspect was the setting up of a modern public hospital network which led to a centralization of public health care provision in the stationary sector (European Observatory on Health Care Systems and Policies 2004).
After transition, however, various shortcomings of this model came to light, namely the inadequate coordination of health care networks and an underdevelopment of primary health care and preventive medicine due to the strong concentration on hospital networks. Furthermore, no universal coverage had been reached under the Franco regime leading to massive health inequalities between different social groups (Ibid. 2004).
Summary of Chapters
1. Introduction: Presents the theoretical context of Esping-Andersen’s typology and introduces the critical question of whether a distinct Southern European welfare regime exists.
2. The Welfare Regime Debate: Outlines the classical three-model classification, summarizes scholarly criticism regarding its limitations, and examines the proposal for a specific Southern regime.
3. Health Care in Southern Countries: Provides a detailed comparative overview of the historical development and current state of health care systems in Spain, Portugal, Italy, and Greece.
4. A Southern Regime in Health Care?: Analyzes whether the shared characteristics of Southern health systems justify a new regime classification or if they reflect developmental gaps.
5. Measuring Welfare Regimes in Health Care – Where do we group the Southern Countries?: Employs Bamba’s decommodification index to empirically test how Southern countries fit within established welfare models.
6. Conclusion: Synthesizes findings to argue against a separate "Southern" regime, suggesting instead that welfare states should be analyzed area-by-area to account for split logics.
Keywords
Welfare State, Esping-Andersen, Southern Regime, Health Care Provision, Decommodification, Social Security, Public Health, OECD, Health Inequalities, Welfare Typology, Mediterranean Welfare, Service Provision, Social Expenditure, Governance, System Development
Frequently Asked Questions
What is the central premise of the research?
The paper argues that the common practice of grouping countries into rigid "three-world" welfare regimes is insufficient, particularly when focusing on specific services like health care, and that Southern countries do not form a truly unique, autonomous regime type.
What are the primary thematic fields covered?
The study centers on welfare regime theory, the evolution of national health systems in Southern Europe, and the methodological application of decommodification indexes in public policy research.
What is the main objective or research question?
The primary objective is to determine if the "Southern" countries (Spain, Portugal, Italy, Greece) possess a sufficiently distinct logic in their health care provision to warrant being classified as a separate fourth welfare regime.
Which scientific methods were employed?
The author uses a comparative institutional analysis, reviewing existing literature and policy frameworks, followed by an empirical application of the decommodification index based on OECD and WHO health care data.
What topics are discussed in the main body?
The main body covers the theoretical foundations of welfare classifications, individual country profiles of Southern health systems, a comparative assessment of these systems, and an evaluation of specialized health care indices.
Which keywords characterize this publication?
Key terms include Welfare State, Southern Regime, Decommodification, Health Care Provision, and Social Security.
How does the Spanish health care system differ from the others mentioned?
The Spanish system is noted for its transition from a restrictive, insurance-based structure under the Franco regime to a decentralized, tax-funded national health system with universal aspirations, though it still faces challenges with waiting times and specialist access.
What role did the recent dictatorships play in Southern health care?
These regimes set the initial stage for public hospital development and social security foundations, but the systems were generally incomplete and fragmented, necessitating significant reform and modernization following the subsequent transitions to democracy.
- Quote paper
- Janine Schildt (Author), 2010, The Welfare Regime Debate and Health Care Provision, Munich, GRIN Verlag, https://www.hausarbeiten.de/document/159976
