Political Determinants of Health: Healthcare Privatization and Population Health in Europe.

The extent to which healthcare reforms affect health remains understudied. Healthcare reforms result in policy outputs that determine provision of medical services, which have consequences for the health of the population. We scrutinize this relationship between health policy outputs and population health, using an original dataset of healthcare reforms passed in 36 European countries from 1989 to 2019. Focusing more specifically on legislative changes implying privatization of healthcare delivery and finance, we ask the following question: What is the relationship between reforms that privatize healthcare provision and population health in terms of health outcomes and inequalities? We answer this question by relying on fixed effects time-series cross-section models. Health outcomes are operationalized using measures of subjective health status, unmet health needs and resulting health inequalities. Our results show that privatization of healthcare is associated with higher rates of bad subjective health and unmet health needs several years after the passing of reforms. These effects are stronger for individuals in the lower tiers of income and education, resulting in higher socio-economic inequalities. The article contributes to conceptualization of the political determinants of health as health policy outputs and a better understanding of the relationship between policy outputs and population health outcomes.