Principles, Mechanisms and Causes of Healthcare Marketisation

Marketisation in healthcare has occurred widely in Europe since the 1980s. However, researchers understand marketisation in healthcare differently or do not understand the phenomena they are researching as part of marketisation. This paper seeks to ground the concept of marketisation of healthcare by outlining the principles, mechanisms and causes of marketisation in six European countries.

I conceptualise healthcare marketisation using three principles: openness to private providers, competition among public, private, and nonprofit sectors, and management autonomy. From these principles I derive a total of 13 marketisation mechanisms which I illustrate using case studies from England, Finland, France, Germany, Greece and Slovenia. These mechanisms constitute possible empirical manifestations of the principles outlined above. I then propose a framework for analysing the causes of healthcare marketisation. These include economic crises, neoliberal ideology, and international institutions as drivers of healthcare marketisation policy. The implementation of marketisation policies depends on the degree of centralisation in political and health systems and on the resources of resistance by civil servants, commissioners or healthcare professions.