ABSTRACT
National health services in Cyprus, Greece, Italy, Malta, Portugal and Spain developed later than in Northern and Western Europe and remain characterized by higher levels of out-of-pocket payments and a powerful private sector. Over the past decade, most health systems in Southern European countries have been severely impacted by the 2009 economic recession and resultant austerity policies. Yet there were differences in the magnitude of the shock and in the responses that countries adopted. The unprecedented surge in the flow of refugees into the countries of the North Mediterranean placed additional pressures on the region. Malta was the only country in Southern Europe to consistently maintain an increase in health expenditure. In contrast, health expenditure in Greece was cut annually by 6%, by 2% in Portugal and Cyprus and by 1% in Spain and Italy between 2009 and 2014. With the exception of Greece, the remaining countries still achieved improvements in amenable mortality rates during this period. Unmet need for health care increased markedly in Greece, but access to services due to cost also worsened in Italy, Cyprus and Portugal. Reforms in medicines policy, primary and specialist care to achieve greater efficiency and sustainability were implemented. At this stage, it is difficult to determine whether the policies implemented in response to the economic shock influenced the ability of these countries to cope with the outbreak of the coronavirus (COVID-19) pandemic and its consequences, since the scale of the impact on health systems was very different.
