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The spread of privatisation and private sector investment in health care across Europe has continued behind the scenes, in some cases on a far larger scale than the marketising and privatisation in England by New Labour since 2000.
According to the Economist (May 21) while only 4% of acute care beds are provided by private companies in Britain (most of these in England), in Germany the proportion of for-profit private hospitals has been higher than publicly-owned ones for the last two years. In the Spanish State, Valencia now has 20% of healthcare services delivered by for-profit companies. In Slovakia 40% of hospital provision is delivered by the private sector.
The growth of private sector hospitals often heralds a rundown of public sector provision: in Germany the government aims to cut the numbers by up to 30% and close one third of hospitals as they implement a McKinsey style plan for rationalisation.
According to private sector analysts Healthcare Europa last December, France, the Netherlands, Poland, Slovakia and the UK are seen as the best immediate prospects for the private sector. But in addition Bulgaria, Serbia, and the Czech Republic are looking to "top up" their public healthcare systems with privately provided health care, and the Netherlands has just seen an injection of private money, with the purchase of a chain of medical centres by one of the country's leading insurance companies.
France has the largest private hospital sector in Europe, with 400 to 600 small operators running 1,250 private hospitals. 11,000 out of 50,000 psychiatric beds are in private hospitals in which patients pay for their own room.
Although private acute hospitals are paid on a lower tariff than public hospitals, they are much smaller and are free to pick and choose only the most minor cases. The introduction of a higher tariff for accident and emergency services has meant 130 private hospitals have opened some kind of A&E service.
Meanwhile the French government has led a restructuring of public sector healthcare, aiming to cut hospital costs by one third in five years. It has established 20 regions in which hospital services are to be "consolidated," threatening closures of many smaller maternity units and local hospitals.
Poland has the most ambitious plans to privatise hospital provision, with a 'corporatisation' of debt-ridden public sector hospitals (effectively turning them into the equivalent of foundation trusts). To be followed, if the government signs the legislation into law, by the commercialisation of these hospitals, to be run as joint stock companies for profit, with their debts written off.
These hospitals, as well as the major private health companies in Poland, the
iggest of which has 12 hospitals, will al
remain dependent for their main revenues on the National Health Insurance Fund.
In Bulgaria, where the private sector has "mushroomed" since 2009 with 40 new (mostly tiny, 20 to 40 bed) private hospitals and clinics, Healthcare Europa points to the emergence of a planned "Asian model" of health provision, replacing universal care with a fixed payment from the National Health Insurance Fund, to be topped up by co-payments from patients. None of this seems too attractive for Bulgarian nurses, one in six of whom left the country to work elsewhere last year.
In Croatia too, state health insurance payments can be used towards private care, which costs roughly double the state tariff: Croatia now has the third largest private hospital in the EU with 220 beds.
Across Europe the private sector in healthcare is clearly dependent upon the continued existence of public and collective funding, and in many cases public services that will continue to treat the high risk, high cost, and chronic cases, to allow smaller private hospitals to "cherry pick" only on elective care.
So when the crisis bites - as now in Greece - private patients can be seen to be switching away from the use of private hospitals where they have to pay additional costs, and resorting to accessing care from public sector providers.
That's why it's so important to defend public provision of health care, the most equitable, effective and efficient way to meet health needs rather than line the pockets of private investors. Across Europe the private sector in healthcare is clearly dependent upon the continued existence of public and collective funding Launch of European health activists network • Campaigners and union activists from six European countries came together to discuss the fight against privatisation and massive cutbacks in health care at a two day conference in Amsterdam at the beginning of May. The initiative flowed from the Polish free trade union 'August 80', which is facing the impending privatisation of hospitals across Poland by the right-wing government there. But reports from Ireland, Sweden, France, Germany and England, showed that governments of all types throughout Europe are engaged in a specific kind of privatisation. This involves slicing off profitable services and a growing share of public funding and collective insurance funding to pay private providers to deliver certain types of health care. This process runs alongside attempts to rein in public spending on health services, causing heavy cuts in services in many public hospitals and facilities. Those present agreed that any fight back against this attack on comprehensive and universal health care requires a mobilisation of the whole population, going well beyond simply campaigns by health workers themselves. The meeting also took the first steps towards establishing a European wide framework to linkup struggles against the policies of privatisation, corruption and health care. And against cutbacks in health services which strike most hard against the poor, the elderly and the chronically sick. The key principles of the network would be a commitment to universal access and comprehensive health care for all, free at the point of use, based on need and not the ability to pay. But also to democracy in health care, with public control of health service planning; and for health care to be based on public or collective funding as opposed to a source of profit for private providers. There was general agreement that the further conference was needed to bring a wider group of countries and activists together, and the target date of 11 November in Poland was set.