Ana M. Guillén

The EU’s Impact on the Spanish Welfare State: The Role of Cognitive Europeanization

This article assesses to what extent the enlargement of the EU towards Spain has impacted the reform of social policies up to the present. Despite the fact that the norms issued by the European Union regarding the regulation of social-protection policies is scant, becoming a member of such a supranational institution can be expected to have influenced the redesign of welfare states either directly or indirectly, thus contributing to the overcoming of path dependence. The article analyses the influence of EU accession on both procedural and substantive aspects, i.e. on the policy-making process and institutional remodelling, and on the design and content of social policies respectively. The article discusses the influence of the EU as compared to that of domestic politics and other international organizations on the redesign of the Spanish welfare state. It concludes that a significant process of ‘cognitive Europeanization’ may be ascertained.

Introduction: Does Europe Matter? Accession to EU and Social Policy Developments in Recent and New Member States

has resulted in much discussion focused on the impact of this change on EU institutions and on EU economics. Nonetheless, much less attention has been devoted to social policy. This special issue on enlargement, Europeanization and social policy is therefore intended to contribute to social policy aspects of enlargement. It asks two questions central to our understanding of social policy and the enlargement process: What is the role of EU governance and institutions in shaping the social dimensions of the enlargement process?; and is it desirable and possible to maintain levels of solidarity in an enlarged market of 450m people? In order to address these two crucial questions, this issue compares various processes of enlargement: the accessions of Greece and Spain are contrasted with preparations for enlargement in Central and Eastern European (CEE) countries. The present issue constitutes a follow-up and enrichment of the debate opened by the Journal of European Social Policy on European enlargement and European integration (Debates section, 13(1), February 2003). Still the accent here is not placed on enlargement or accession per se but rather on Europeanization. Europeanization is the main reference point cross-cutting all contributions. Each contribution deals with the interplay, or lack of it, between EU and national (and subnational) policy making. The aim of the issue lies in the identification of the ways in which the EU may matter among new and older member states for shaping national social-policy developments. The issue includes seven contributions, covring a wide-ranging set of processes and trends of reform. The first and the last of them provide a general view of Eastern European welfare states. Nick Manning assesses changes in eight of the accession countries since 1989 and also analyses broad processes of evolution in the whole CEE area, thus offering crucial information on where accession countries stand among their neighbours, and on which reform trajectories are shared and which not. In turn, Noémi Lendvai’s review essay addresses academic debates on the social dimension of enlargement, the diversity of accession processes, and the issue of interterritorial solidarity. Four of the contributions are case-studies, devoted to Hungary, the Czech Republic, Greece and Spain (authored by Zsuzsa Ferge and Gábor Juhász; Martin Potůc̆ek; Dimitri Sotiropoulos; and Ana Guillén and Santiago Álvarez respectively). The literature on Southern Europe generally confirms that Mediterranean countries have ‘caught up’ from entering the EU as far as the development of their welfare system is concerned. The idea of comparing accession to the EU by two Southern and two Eastern countries was, first, to look for the conditions that allowed the catch-up scenario for Southern Europe and, second, to see whether these conditions are to be found in the case of CEE countries. The basic question is to see whether, and under which conditions, becoming a member of the EU makes a difference for national member state social-policy developments. In order to organize this comparison, the same questions are addressed in each national case and, thus, in markedly different contexts. Introduction: Does Europe matter? Accession to EU and social policy developments in recent and new member states

Adopting and adapting managed competition: health care reform in Southern Europe

A new paradigm appeared in Europe in the early 1990 s regarding the reform of health care systems. This paradigm has come to be known as the managed competition paradigm, among other terms. First introduced in Great Britain, it entails the separation of the financing/purchasing and providing functions, so that competition among providers is enhanced, while maintaining universal access and public financing, at least in principle. This article explores to what extent such paradigm has been emulated within the Greek, Italian, Portuguese and Spanish health care systems. Reform in the direction of managed competition may be ascertained in all four countries. However, each country has emphasized different aspects of the paradigm, and the degree and rhythm of implementation of reform has varied. The article considers the circumstances under which the new paradigm was born, and its main characteristics; analyzes actual reforms in Southern European countries; and provides a tentative explanation of the diffusion mechanisms. It concludes that the crucial factor explaining the different paths of policy adoption and adaptation is the character of the initial health care system.

Can the Welfare State as We Know It Survive? A View from the Crisis-Ridden South European Periphery

South European countries have been hit hardest and longest by the post-2008 economic crisis. This has brought their welfare states under acute strain. Unmet need has sharply increased while significant welfare reforms and (more or less) deep cuts and changes in social spending have been prominent in the repertoire of the crisis management solutions implemented by the governments (under European Union constraints and the strict rescue-deal requirements for Greece and Portugal). This introduction briefly reviews reform trends prior to and during the crisis in order to highlight convergent and divergent paths among the four countries and outline the major questions addressed by the contributions to this volume.

Redesigning the Spanish and Portuguese welfare states: The impact of accession into the European Union

Despite the fact that the norms issued by the European Union regarding the regulation of social protection policies are scant, becoming a member of such a supranational institution can be expected to have influenced the redesign of welfare states. The present paper assesses the extent to which the enlargement of the EU towards the South has impacted the reform of social policies. In particular, it focuses on the cases of Spain and Portugal. The paper includes both a quantitative and a qualitative analysis. From the quantitative point of view, it assesses the evolution of financing and expenditure trends. From the qualitative point of view, it analyses direct and indirect effects of EU membership on social policy, and considers the development of social policy in the domestic sphere in relation to the European Social Model. The concluding section discusses the influence of both external and internal interests and challenges in the redesign of the Spanish and Portuguese welfare states.

South European Healthcare Systems under Harsh Austerity: A Progress–Regression Mix?

This article addresses the question of whether the economic crisis provides a politically opportune time to drastically curtail public healthcare in South Europe or whether, instead, there are signs of longer-term reform strategies for potentially balancing fiscal targets with the quest for enhanced value and health outcomes, when eventually growth resumes. After a brief examination of the profile of healthcare systems in Greece, Italy, Portugal and Spain prior to the crisis, we comparatively assess the mix of retrenchment, restructuring and recalibration strategies. The effects of the austerity-driven reforms on current (and expected) health outcomes are also briefly analysed. We conclude with reflections on the future of public healthcare in South Europe.

Globalization and the Southern Welfare States

This chapter is devoted to the analysis of the relationship between social policy reform and globalization in Italy and Spain, both southern European countries and members of the European Union. Reference will also be made to Portugal and Greece, which share similar conditions. A caveat should be introduced here regarding the use of the term ‘southern’, since confusion is possible between the usages of ‘southern’ denoting a geographical area, and also as a theoretical construct or model. For clarity, we therefore use ‘southern’ (i.e. small ‘s’) when using the term generally/geographically, and ‘Southern’ (i.e. capital ‘S’) when referring to the family of welfare states in a model or regime-like sense.

Citizenship and Social Policy in Democratic Spain: The Reformulation of the Francoist Welfare State

Abstract The activities of the Francoist regime (1939–75) in the field of social policy resulted in the construction of a welfare system covering slightly over eighty per cent of the population and organized along corporatist lines, with significant dissimilarities among the different professional categories. This article examines the development of the Spanish welfare state during the last two decades of democratic rule – a period in which coverage was significantly expanded, a process of decentralization occurred and several cost control measures began to be introduced. In particular, the article analyses the changes that have taken place in the domains of income maintenance, health care and personal social services. It also considers the impact of those changes on the macro-institutional design of the welfare system, as well as on the conditions of access and equality. Finally, attention is paid to the role played by the family as a provider of social services in Spain.

Reforming pharmaceutical policies in the European Union: a "penguin effect"?

Pharmaceutical policies form a substantial part of health care services, from the point of view of both equity and efficiency goals. Expenditure on pharmaceuticals has been growing steadily over the last few decades, and countries are finding the financing of drugs increasingly difficult. This article surveys the changes in pharmaceutical policies in the E.U. countries from the mid-1980s through the 1990s. It focuses primarily on policies dealing with cost control of publicly funded pharmaceuticals. In their analysis of these changes, the authors classify policies (or “packages of measures”), map out their incidence in each country, and assess their impact on the control of public pharmaceutical spending. They conclude that the E.U. countries are taking up apparently similar measures—dressing like penguins in a row—despite the limited effectiveness and limited evaluation of many of the measures adopted. The authors also analyze the role of national and international actors (most prominently, the European Union) in defining public pharmaceutical policies; look at how innovative policy ideas could be connected with the economic, political, and social interests that mold public action in this field; and propose new lines of investigation.

Towards a National Health Service in Spain: the Search for Equity and Efficiency

All Southern European countries have enacted reform laws during the last decade with the in tention of turning their traditional social- security health-care systems into national health services. Spain was no exception to this reform thrust and the General Health Law of 1986 brought about a significant institutional change. The purpose of this article is twofold. First, it assesses the decision-making process that led to the approval of the 1986 reform law by contemplating the roles played by the main social and political actors. Moreover, the influence of policy legacies and the impact of regime change are considered. Second, the article evaluates the implementation process of the reform law as regards the coverage criteria and span, the financial sources and the services provided. The analysis of these indicators leads to the conclusion that the health-care system in Spain has been transformed into a national health service, although some minor characteristics of the previous model persist.