What's different in Southern Europe? The question of citizens’ participation in health systems

Abstract

Contemporary governance demands mutual interdependence of actors through participatory devices in order to competently address public problems and improve the quality of decisions. This debate is actively present within the health system where several international organizations have been exhorting national governments to develop public spaces within civil society as the proper locations for the improvement of their health systems. To date, several initiatives have been put forward and substantial resources have been invested in the design and implementation of citizens’ participation exercises in the health domain. The main focus of this paper is civil society's involvement with health systems. It analyses the characteristics of the Greek, Italian, Portuguese, and Spanish health systems and the main steps in their reform processes. The most relevant initiatives of citizen participation are identified, highlighting their key features and potential, as well as the main critical issues raised. The evolution of the national health services in the countries analysed shares a common history, as well as similar models for the provision of health services in the case of Italy, Portugal, and Spain. With the exception of Greece, where participation is in an early stage, the participatory activities implemented in the other three countries revealed common features: I) a gap between the discourse on the importance of citizens' participation that permeated the reform processes and the practices implemented within health services; II) most of the experiments only take place at a local or regional level; III) the changes of governments have been negatively affecting the consolidation of participatory experiences.