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This STG Resilience Paper is part of the Commission Research Report and Interim Progress Report (June 2021) published by Reform for Resilience. • It remains unclear which specific aspects of the health system play the most important role in the handling of the COVID-19 pandemic and whether there are regional differences among healthcare systems that explain different effects of the pandemic on countries across Europe. • This policy brief builds on the analysis of links between three institutional dimensions of health systems – financial input, infrastructure input and workforce input – and the number of excess deaths in 30 Eastern and Western European countries during the first and the second waves of the pandemic. This analysis provides three main findings. • Firstly, higher monetary input into the healthcare system, characteristic for the countries in Western Europe coming from public sources is linked to a lower number of excess deaths. Instead, higher monetary input coming from private sources, patients' out-of-pocket payments for healthcare, is linked to a higher number of deaths in Eastern Europe. Secondly, a higher input of healthcare workforce in form of general practitioners and nurses in Western Europe is linked to lower number of excess deaths. Thirdly, these health system characteristics have a stronger impact during periods where infection rates are high. • This policy brief specifies the following two policy recommendations, which hold particularly for Eastern Europe. One is that in order to strengthen healthcare system resilience to the present and future pandemics, countries should increase public and reduce private spending for healthcare services. Another recommendation is that healthcare systems should strengthen their primary care by increasing the numbers of general practitioners and by increasing the supply of nurses. In the absence of these, governments need to rely more unilaterally on costly restrictive measures in order to prevent the health system from being overrun.

Laboratorio di Politica Comparata e Filosofia Pubblica (LPF) In the 2000s, in two Central Eastern European (CEE) countries - Slovakia and Hungary - governments proposed plans for welfare reforms that entailed radical shift from a state- to a market-oriented healthcare system. This paper focuses on the following question: Why did the governments in the two countries propose these reforms when support for the state-run healthcare in these two post-communist countries is still high? The paper shows that the healthcare policy reforms of the two Central Eastern European countries cannot be explained by the dominant accounts of policy change that assign key role to the characteristics of the government, such as its political orientation. Instead, the paper argues that the emergence of market-oriented reforms in the two countries is best explained by neoliberal ideas that strongly influenced government healthcare agenda. The neoliberal ideas built upon belief in the superiority of the market over the state and strongly influenced the CEE governments’ plans for healthcare reforms offering solutions for two core policy problems - the healthcare sector-specific deficits and the increased pressures for budgetary control in the context of Europeanization.

Defence date: 24 November 2014 Examining Board: Professor Sven Steinmo, EUI (Supervisor); Professor László Bruszt, EUI; Professor Ana Marta Guillén Rodríguez, University of Oviedo; Professor Ellen Immergut, Humboldt University Berlin. What determines the pace of policy innovation and change? Why, in other words, do policy makers in some countries innovate faster than in others? This thesis challenges conventional explanations, according to which policy change occurs in response to class conflict, partisan preferences, power of professional groups, or institutional and policy legacies. The thesis instead argues that different paths of policy change can be best explained by the different learning processes by which policy makers develop ideas for new policies in reaction to old policies. The thesis draws upon both ideational and institutional streams of literature on policy change, and develops its argument that policy change, understood as a learning process, is a result of interactions between three different, yet interdependent factors – ideas, interests and institutions. The thesis explores this argument by investigating in detail two radical cases of policy innovation – the introduction of market-oriented elements in Czech and Polish healthcare policy during the first two post-communist decades. The selection of the two cases is based on the methodological rationale of the 'most similar system design', given that the healthcare systems of the two countries were both state-dominated under communism, while in the post-communist period the governments of the two countries introduced market-oriented reforms that followed rather divergent policy paths. While Czech reforms were relatively consistent and comprehensive, those in Poland were fragmented, delayed and beset with reversals. The thesis looks at these two cases of healthcare reforms from a long-term historical perspective, covering the inter-war, the communist and, most thoroughly, the post-communist period. It draws upon the official documents, secondary literature and more than 40 interviews with policy making elites, and compares the two policy paths using small-N research design, causal analysis and process tracing techniques. The main finding of the thesis is that the market-oriented ideas that occurred in healthcare policy circles during the 1970s and 1980s were crucial drivers of the post-communist reforms in the two countries. However, the capacity of these ideas to serve as a basis of policy change was dependent on two factors – on the existence of political actors who were willing to promote these ideas, and on the interaction of institutional veto points with the electoral and partisan dynamic. The findings of this thesis contribute to the better integration of the literatures on the role of ideational and institutional factors in policy change, and to the research on the causes and consequences of marketization in healthcare and, more broadly, in social policy.

Health Politics in Europe: A Handbook is a work of reference that provides historical background and up-to-date information and analysis on health politics and health systems throughout Europe. In particular, it captures developments that have taken place since the end of the Cold War, a turning point for many European health systems, with most post-communist transition countries privatizing their state-run health systems, and many Western European health systems experimenting with new public management and other market-oriented health reforms. Following three introductory, stage-setting chapters, the handbook offers country cases divided into seven regional sections, each of which begins with a short regional outlook chapter that highlights the region’s common characteristics and divergent paths taken by the separate countries, including comparative data on health system financing, healthcare access, and the political salience of health. Each regional section contains at least one detailed main case, followed by shorter treatments of the other countries in the region. Country chapters comprise an historical overview focusing on the country’s progression through a series of political regimes and the consequences of this history for the health system; an overview of the institutions and functioning of the contemporary health system; and a political narrative tracing the politics of health policy since 1989. This political narrative, the core of each country case, examines key health reforms in order to understand the political motivations and dynamics behind them and their impact on public opinion and political legitimacy. The handbook’s systematic structure makes it useful for country-specific, cross-national, and topical research and analysis. -- Part I. Introduction -- 1.Health Politics Today, Ellen M. Immegut -- 2.Health Outcomes and Health Inequalities, 1. Simone M. Schneider, Ave Roots, and Katharina Rathmann --3.Public Opinion and Healthcare Attitudes, Diana Burlacu and Andra Roescu -- Part II. Ireland and the UK -- 4.Regional Outlook. Ireland and the UK, Jane Gingrich and Scott L. Greer -- 5.Ireland, Camilla Devitt -- 6.1. The UK. England, Scotland, Wales, and Northern Ireland, Jane Gingrich and Scott L. Greer -- Part III. The Nordic Countries -- 7.Regional Outlook. The Nordic Countries, Ellen M. Immergut and Maria Oskarson -- 8.Sweden, Paula Blomqvist and Ulrika Winblad -- 9.Denmark, Karsten Vrangbæk -- 10.Finland, Liina-Kaisa Tynkkynen, Meri Koivusalo and Ilmo Keskimäki -- 11.Norway, Mi Ah Schoyen -- Part IV. Southern Europe -- 12.Regional Outlook. Southern Europe, Elisa Chuliá and Karen M. Anderson -- 13.Portugal, Maria Asensio -- 14.Italy, Franca Maino and Federico Razetti -- 15.Spain, Elisa Chuliá -- 16.Greece, Ilias Kyriopoulos and Elias Mossialos -- 17.Cyprus, 1. Mamas Theodorou and Kostas Athanasakis -- Part V. The Baltic Countries -- 18.Regional Outlook. The Baltic Countries, Mare Ainsaar and Ave Roots -- 19.Estonia, Mare Ainsaar, Ave Roots, and Jüri Kõre -- 20.Latvia, Edgars Eihmanis -- 21.Lithuania, Liubovė Murauskienė -- Part VI. Continental Europe -- 22.Regional Outlook. Continental Europe, Ellen M. Immergut -- 23.Germany, Ellen M. Immergut and Claus Wendt -- 24.The Netherlands, Karen M. Anderson and Ruud J. van Druenen -- 25.France, Matthias Brunn and Patrick Hassenteufel -- 26.Belgium, Julia Lynch and Chris Vermorken -- 27.Luxembourg, Anja Leist -- 28.Austria, Carina Diesenreiter and Claus Wendt -- 29.Switzerland, Christian Rüefli -- Part VII. Central Eastern Europe -- 30.Regional Outlook. Central Eastern Europe, Tamara Popic -- 31.Czech Republic, Tamara Popic -- 32.Hungary, Mária Éva Földes -- 33.Poland, Tamara Popic -- 34.Slovakia, Tamara Popic -- 35.Slovenia, Tamara Popic -- Part VIII. Southern Eastern Europe -- 36.Regional Outlook. Southern Eastern Europe, Tamara Popic and Guergana Stolarov-Demuth -- 37.Bulgaria, Guergana Stolarov-Demuth -- 38.Albania, Mirza Balaj -- 39.Romania, Diana Burlacu and Alexandru Daniel Moise -- 40.Former Yugoslavia, Tamara Popic and Natalija Periśić -- 41.Croatia, Tamara Popic -- 42.Serbia, Tamara Popic -- 43.Montenegro, Natalija Periśić -- 44.North Macedonia, Simonida Kacarska and Neda Milevska Kostova -- 45.Bosnia and Herzegovina, Jasmin Hasić -- 46.Kosovo, Arta Uka