National Health Services of Western Europe. Challenges, reforms and future perspectives. By G.Giarelli and M.Saks, Abingdon/New York: Routledge. 2024. pp. 340. £108.00 (hbk); £31.99 (ebk). ISBN: 9780367689599

Since the outbreak of the 2020–2023 COVID-19 pandemic, health-care provision and the role of the National Health Services (NHSs) has been at the centre of the discussions concerning a partial return of welfarism, at least in most Western countries. However, much of this debate has involved ideological stereotypes and political aspirations that simplify the complexity of welfare states and how health-care policies work. In this respect, National Health Services of Western Europe. Challenges, Reforms and Future Perspectives, edited and coordinated by Professors Guido Giarelli and Mike Saks, provides a detailed theoretical and empirical contribution regarding the evolution and structural challenges that confront NHSs in Western Europe. As the title suggests, and clearly encapsulates, the book focuses on the transformations in health-care institutional designs in a selection of countries, classified in three macro-regions: Britain (England, Scotland, and Wales), Scandinavia (Sweden, Denmark, and Norway), and the Mediterranean (Italy, Spain, Portugal, and Greece). Made up of chapters contributed by well-reputed authors in medical sociology, the book achieves a comprehensive and well-structured book based on neo-Weberian and neo-institutionalist approaches. This can be observed in the presentation of the main hypothesis and research questions that scrutinise the role of the state and other relevant factors such as the practitioners' associations, civil society organisations, and the medical–industrial complex in each case study (Part I) before a general comparison (Part II). According to the conclusions by Giarelli and Saks, health-care provision systems are difficult to classify in a static and monolithic typology that identifies an iconic NHS model, currently under hybridisation after several decade-old reforms and demographic transformations. This leads to a first observation in which different path-dependencies and path-deviations show a divergent NHS model in each case study where the state plays a main role despite the heavy influence of the private sector. Second, despite similarities within macro-regions, there are certainly strong differences concerning the power balance and historical status held by physicians and general practitioners (GPs), usually linked to a specific state-building process and hegemonic medical culture. Furthermore, and dialoging with the book's analyses, the impact of neoliberalism in restructuring health-care provision since the 1970s strongly differs between cases studies and macro-regions as it depends on political arenas, cultures, and elites. In this sense, the proposed neo-Weberian approach helps identify the importance that professional categories and organisations play in conforming a particular institutionalisation of health care. Plus, the neo-institutionalist approach contributes to analyse how NHS systems are the result of historical conflicts and contestations where different factors acknowledge setup costs, learning and coordination effects, and adaptive expectations. As a result, changes in health-care policies and institutions coexist with surviving norms and values. This explains how, in general terms, traditional bureaucratic structures intertwine with New Public Management (NPM) strategies in public administration. Consequently, neoliberal reforms tend to be diluted and disputed within the state, despite a strong management rhetoric concerning austerity, deregulation, and marketisation of public health-care services as a way of increasing efficiency. Thus neoliberal discourses concerning the privatisation of health care depend on accompanying practices, values, and power structures within and outside the state—for example, hospital administrations—as observed by Foucault despite the book's critique of his theoretical generalisations. In this sense, admitting the ideological and cultural relevance of neoliberalism in the promotion of individual-centred transformations and weakening state-led decision-making, the book successfully addresses the conformation of hybrid health-care regimes. This is named as the emergence of a neo-Beveridgian model in which NHSs are neither fully controlled by the state or the private sector due to a governance paradigm, as foreseen by Foucault. Accordingly, as most of the book's authors point out, nowadays health-care provision exists alongside quasi-markets highly controlled by the public sector, but are notoriously influenced by (inter)national medical–industrial lobbies. Also, in most cases, groups of interest play a role as, for example, patients' associations may become part of the negotiating process in addition to practitioners' organisations and trade unions. Therefore, the institutional complexity of dense negotiating networks, hybrid medicalisation regimes, and health-care policies in Western Europe is clearly exposed in the book. In conclusion, National Health Services of Western Europe. Challenges, Reforms and Future Perspectives is a must-read guide for understanding the direction taken by health-care provision designs not only in Western Europe, but also worldwide. As the COVID-19 pandemic settles as an element of the past, new epidemics and demographic realities pose a yet-to-come stark challenge to NHSs across the world. In this sense, this book is strongly recommended for researchers, policy-makers, and leading health professionals that may be interested in broadening their perspectives of how institutional configurations of health care are framed.