Economic crisis and inequalities in health systems in the countries of Southern Europe.

The current article addresses the issue of health system inequalities in the countries of Southern Europe, specifically Spain, Greece, Italy, and Portugal. The study resulted from a non-systematic literature review, based on the scoping review proposal. We begin by presenting a brief contextualization of the social welfare state systems in these European countries, highlighting the principal specificities and differences in relation to other European welfare state systems. Next, we describe the health systems in the four countries, emphasizing the respective reform processes and the main health inequalities that have characterized them before and during the economic crisis. The crisis and austerity policies have greatly increased the level of dissatisfaction with healthcare provision in these countries, particularly in Greece and Portugal. In this sense, we conduct a comparative discussion of the health inequalities, identifying both common trends and differences. In the four countries, the social gradient (particularly in education, income, and labor) represents the principal determinant of health inequalities, while not ruling out geographic inequalities in access to health services as the result of different levels of economic development in the various regions. Finally, we discuss the recent debate in the international literature on the relationship between different welfare state systems and health inequalities, and precisely the critique of the use of welfare state typologies as a determinant of health and health inequalities.