The immediate impact of the coronavirus crisis on individual well-being depends on the ability of the health system to deal with the pandemic. Countries differed widely with regard to the qualification of their health system. From a Political Economy perspective, a core question is whether a national health system should be predominantly private or public. Moreover, the coronavirus crisis caught health infrastructure of some countries unprepared, after several decades of lowering investment in health systems. Why was this the case and what can be done about it? Finally, some countries have autonomous and powerful central health agencies, whereas others incorporate questions of public health into government ministries. Which strategy was more successful?

Health systems in Political Economy

Health systems can be predominantly organized in a private or in a public way. A good example for the latter would be Scandinavian health systems, but also the core of the National Health Service (NHS) in the United Kingdom that defies the usual classification of the UK as a welfare state with a high degree of commodification. The principle of commodification generally assumes that the individual has to cater for protection mostly himself or herself and that health protection should be based on the market logic (Andersson, 2020: 30; see also Chapter 3). The most well-known case for a predominantly private health system is the United States where health provision even has become an important focus for financial market speculation during the last decade (see Chapter 13).

However, health systems are not necessarily ‘born’ private or public; their character can change over time. A widely discussed issue in Political Economy scholarship is the privatization of public services, including health systems. Privatization has been a core element of the rise of (neo)liberal capitalism since the 1980s (Menz, 2017: 244–52; Eagleton-Pierce, 2019; see Chapter 31). Privatization of healthcare can incorporate several elements, notably including the selling off of public healthcare facilities to investors and the increasing financing of health provisions via private insurances and fees. However, even without straightforward privatization we have seen a tendency towards the incorporation of market mechanisms in healthcare; for example, by introducing competition between (public) healthcare providers (Eckhardt and Lee, 2019: 668–9).