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date: 20 July 2019

Abstract and Keywords

The main aim of this article is to account for the coming of health systems within welfare states and to examine how these systems respond to demographic, financial, and technological changes in the contemporary period. The question of why the state entered this arena in the recent past is therefore of over-arching importance, and this article summarizes common theoretical approaches advanced to explain this process. It outlines the nineteenth-century foundations of social insurance and public provision of medical facilities on which state engagement was built. It traces the growth and development of health systems in the case-study countries, dividing events into three broad periods: the early twentieth century, in which they were largely put in place; the post-war ‘golden-age’ of the welfare state; and attempts since the 1970s to reform health systems in response to burgeoning costs and ideological critique. The conclusion reflects on how the different models adopted have impacted on population health.

Keywords: health systems, medical facilities, population health, welfare states, contemporary period

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