Health policies in Europe: welfare states in a market era.

Across Western Europe, social welfare regimes are under stress. Social scientists have been announcing “the crisis of the welfare state” for a half century-and now a crisis may actually be upon us. As a result, health care policy is up for political grabs. Everywhere states are rethinking their approaches to health care; competitive forces are stirring, often organized and directed by public officials. The state, markets, and medicine mix in different ways in different places. But the same questions emerge: How is the state reorganizing its role? What will be medicine’s political and professional status in the new order? And, most importantly, can the “culture of solidarity’’-the universalist social welfare vision-survive the rise of market competition and global capitalism? The articles in this issue all grapple with these questions. And, drawing on the experiences of different countries, they come up with very different answers. In this introduction, we suggest an overarching political frame. First we sort out the perspectives on the contemporary health care scene. Then we turn to the social forces that are disrupting traditional welfare arrangements: immigration and capitalism. Finally, we scan across cases to generalize about the major agents in the struggle over health policypoliticians, providers, and publics.