Understanding Social Policy in Europe

Alan Walker and Gerhard Naegele, eds. The Politics of Old Age in Europe. Buckingham: Open University Press, 1999. 237 pp. $95.00 cloth; $28.95 paper.

Richard Saltman, Josep Figueras, and Constantino Sakellarides, eds. Critical Challenges for Health Care Reform in Europe. Buckingham: Open University Press, 1998. 448 pp. $115.00 cloth; $34.95 paper.

What are comparative books on social policy supposed to do? The quick answer is more and more. Both the discipline of social policy, and the context in which social policy changes, seemingly become more complicated. Comparative books on the study of health, social care, and political representation must render (in both senses) the increasing richness, complexity, and volume of writing that appears in the social policy literature; and they must do so in a way which is alert to the increasingly demanding requirements of a global economic and political system, for books must be concerned with relevance and user-friendliness for a diverse audience. The comparative study of social policy is not just constituted by the sum of its research and current debates about health care reform in Europe (Saltman, Figueras, and Sakellarides 1998) and the political participation of older people in Europe (Walker and Naegele 1998), but also by how it provides a deeper understanding of the social position of European populations. Comparative books on social policy are very powerful instruments for the creation of a disciplinary canon, a "character" about European cultures.

As part of this literature, Critical Challenges for Health Care Reform in Europe, edited by Richard Saltman, Josep Figueras, and Constantino Sakellarides, seeks to provide the street-level bureaucrat a view of health care policy processes that cut right across Europe. The book is exceptional, with lively and exhaustive topics discussed, and is oriented around four major themes: the context of health care reforms; demand and supply side strategies; the roles of state and citizen; and the implementation of reform. Similarly, The Politics of Old Age in Europe, edited by Alan Walker and Gerhard Naegele, conveys the principal messages that "the politics of old age in Europe has entered a critical new phase" (6) and that there is a pressing need for governments and other agencies to respond to changing circumstances of an aging European population. Both books highlight how European political processes have become preoccupied with the fiscal support of the delivery of social services to an aging population as this demographic shift alters the balance between those in work and paying taxes, and those in retirement receiving benefits and consuming health care and other social services. Both books, however, highlight a question that should be more pressing: What can be done to prevent the exclusion of the elderly from the decision-making processes of societies which perceive the elderly to be a burden because of the welfare costs they impose?

Saltman and his colleagues highlight startling continuities in accepted health care policy across Europe. As they show, throughout the 1980s and 1990s European governments uniformly sought to introduce market dynamics into the delivery of services by creating quasi-markets that rely on internal commissioning and purchasing by providers. In the United Kingdom for example, legislation required that local authorities embark upon a phased program, directed by central government, of compulsory competitive tendering, with the strategy of decreasing the role of local authorities and stimulating greater provision of services by the private sector. This program, like its cousins elsewhere on the continent, rested on the belief that a competitive market and a mixed economy of welfare inevitably provides services that are better and cheaper than those available through the public sector, the reasoning being that a protected public bureaucracy is capable only of furnishing services that are limited, inflexible, and indeterminate and many users are unable to obtain the services they require. As the contributors show, western governments assume that they can put in place a mixed economy of welfare to...