Health care policy has been a crucible of welfare reform in Europe for a quarter of a century and for good reason: there is a tremendous amount at stake. We argue that the ‘epidemic’ of reform – to use Rudolf Klein’s word1

– has been driven by three linked forces. The first arises from what might be called the welfare dimension of health care. Health care matters. Not often, but sometimes, it is a matter of life and death. More usually, it represents a powerful means of alleviating the anxiety, discomfort and incapacity that come from sickness and ill health. Being able to go to the doctor is one of the hallmarks of citizenship in most advanced industrial countries. Not least because of this, health care programmes are – alongside education – generally the largest in European welfare states, and efforts to restructure the wider welfare state inevitably involve efforts to reshape the ‘health care state’.2 In particular, health care has been deeply implicated in the fiscal pressures on modern welfare states.