Background
The Swedish healthcare system is tax-funded and universal with low copayments, governed by politicians at national, regional and local levels. Since the early 1990s, the healthcare system has gradually been transformed from a mainly public system to an increasingly private for-profit driven, but still tax-financed system. This article describes the main driving forces and their effects.
Methods
The marketization of healthcare is contrasted to the legal and ethical framework established by the Swedish parliament for the healthcare system. The Swedish Health and Medical Services Act states that care should be provided solely according to need and on equal terms for the whole population, prioritizing those with greater need.
Results
Since the 1990s private enterprises and lobbyists have argued for market-oriented reforms where for-profit private providers can freely locate and operate outpatient services on public funding. A so-called choice reform (LOV) was implemented in 2010, mandatory in primary healthcare but optional in specialist care. This led to an expansion of for-profit private providers. In 2024, 52% of primary care visits and 22% of specialist care visits were to private providers. LOV has greatly reduced the power of regions to govern healthcare. It favours patients with limited rather than those with greater and more complex needs; it increases inequities in access between rural and urban areas, and between urban high- and low-income areas. The increase in private specialists has also enabled an increase in private healthcare insurance coverage, allowing the insured faster access to specialist care within the tax-financed healthcare system. This is inconsistent with the Health and Medical Services Act.
Conclusion
Marketization has increased inequalities in access to care in Sweden. Studies are needed on how to strengthen the primary healthcare system and to address inequalities in healthcare services related to increased privatization and marketization.

This essay sketches the class structure that a large-scale deployment of artificial intelligence might produce in advanced economies. Because AI is a general-purpose technology, its aggregate effects cannot be predicted, but three consequences can be reasoned through: output per unit of live labor will rise; a surplus population of the durably unemployable, potentially 15 to 20 percent of the labor force, may emerge; and the mass of profit will grow even if the rate of profit does not. The result is a tetra society of four classes: a surplus population kept quiescent by transfers and cheap entertainment, a precarious service-sector working class, a homoploutic elite combining high labor and capital incomes, and a small stratum of techno-lords. Such a society would lack a middle class in the twentieth-century sense, and richer, more AI-intensive societies could therefore prove more politically unstable than poorer ones.

South Africa’s National Health Insurance (NHI) reform was enacted in May 2024. It is the country’s most ambitious effort to achieve universal health coverage (UHC). South Africa has one of the most unequal healthcare systems globally. NHI debates are often framed in technical terms, focusing on cost and feasibility. This analysis shows that power relations and stakeholder interests fundamentally shape the reform’s design. This study draws on policy documents, parliamentary records, and stakeholder submissions from 2011 to 2024, with the political background from 2007 and legal documents to 2026. It applies Walt and Gilson’s policy triangle framework to examine how context, actors, and policy content interact. Key design provisions were embedded in the policy from its inception. These include the continuing voluntary role of medical schemes and accreditation frameworks for private healthcare providers. They reflect the private sector’s structural influence and fiscal constraints rooted in South Africa’s political economy. These are not concessions made during legislative passage. Public-interest civil society organizations were substantively engaged in the NHI process. These include health rights groups, trade unions, and rural health networks. Their influence was limited by restricted access to decision-making forums. The analysis draws lessons for policymakers pursuing UHC reform in contexts where the private health sector is powerful and governance is fragmented. Effective implementation requires governance capacity before or alongside financing. Sustained civil society engagement is an essential mechanism of accountability.

Background
Deriving measures of policy effects from policy documents requires accurate information on what policies were in force, when they took effect, and what provisions they contained. Government publication and preservation practices can make this history difficult to reconstruct. This study presents and evaluates a workflow for constructing longitudinal policy measures in one national policy series.
Methods
A workflow combining document recovery, automated extraction with human validation, and construction of longitudinal measures was applied to NHS England’s Additional Roles Reimbursement Scheme (ARRS) from 2019/20 to 2026/27. Fourteen policy versions were split chronologically into eight development versions and six later versions used to evaluate keyword, deterministic, and large language model (LLM) extraction against an author-verified reference. Three simplified measurement strategies were compared with the validated longitudinal record.
Results
Historical reconstruction recovered 14 substantive policy versions across eight years, while the NHS England landing page exposed documents from only one policy year. Reimbursable workforce categories increased from 5 to 27 between 2019 and 2026. On the evaluation versions, the LLM matched all scored targets for eligibility status, effective dates, and reimbursement amounts, while eligibility conditions were less accurately extracted. Simplified measurement strategies altered the reconstructed exposure history. Using one policy document per year credited 96 category-months before eligibility began, equivalent to 7.3% of the 1,320 eligible category-months, while keyword coding produced 138 category-month errors, equivalent to 10.5%.
Conclusion
In this policy series, the workflow recovered a broader historical record than current web access alone and extracted predefined variables accurately, yet accurate extraction of eligibility conditions and new policy content presented challenges. Valid longitudinal measurement required historical source recovery, explicit coding and dating rules, evaluation on later versions, and human verification. The workflow can offer a structured approach to measuring changes in governmental decisions about eligibility, financing, and conditions over time.

Background
Far-right populist parties have gained significant electoral success across the world, yet little attention has been paid to whether and how they shape health and contribute to health inequalities.
Methods
We conducted a scoping review to synthesize the available evidence on the link between far-right populism and health. We searched PubMed and Scopus between May and June 2026 to identify studies investigating this link.
Results
The review suggests that the health consequences of far-right populism can be understood across at least three levels: (1) the individual level, at which support for far-right populist ideologies may decrease individual health and foster adverse health behaviors; (2) the interpersonal level, at which exclusionary rhetoric may foster discrimination, stigma, and social exclusion and hostile social climates, with implications particularly for marginalized groups; and (3) the societal level, at which far-right populist governance may influence population health via welfare chauvinism and exclusionary policies that affect the social determinants of health.
Conclusion
Based on the emerging patterns identified in our review, we propose a preliminary three-level framework for understanding how far-right populism may be linked to health. This framework helps to integrate existing findings across the individual, interpersonal, and societal level. The evidence base is still developing, and more systematic, longitudinal, and comparative research is needed to better understand potential causal relationships.

Comparative scholarship on health systems has largely relied on institutional approaches, based mainly on the public–private divide. This article argues that political dynamics are central to understanding the shaping and evolution of health systems. France offers a particularly instructive case due to the complexity of its system: intertwined public-private mix, changing modes of governance, persistence of historically rooted arrangements and institutional disjunctures. Drawing on policy tracing, with attention to critical realism, and conducting a contextual and historical analysis, the article shows how actor configurations, power resources, ideological conflicts and political crises have structured the French health system over time. The introduction presents the characteristics and paradoxes of the French system, which this article contributes to explain. The following two sections trace the separate institutionalisation of the two key policy actors: first, the nineteenth-century formation of the medical profession, structured as a national scientific elite, local political notability, and a corporatist organisation ; second, the belated and contingent construction of a national health insurance system, confronted with the resistance of organised medical liberalism. The third section analyses how the power relationship between the medical profession and the government have evolved after a major change of the political regime (Vth Republic) and pressure from economic and social challenges, such as modernizing hospital infrastructure, universalising access and containing expenditure. It shows growing government leadership, and yet limited statecraft over parts of health sector. The conclusion points to the interest of long-term policy tracing, as a method that allows to uncover underlying power structures and identify the causal factors of change, an approach applicable to other national cases.

Drawing on our book Neoliberal Epidemics: How politics makes us sick (2nd edition, 2025), this article sets out how neoliberalism - the hegemonic political–economy of the last 50 years - has operated as a powerful upstream determinant of population health acting through four interlocking and mutually reinforcing pathways: widening socioeconomic inequality, chronic psychosocial stress, pervasive economic and social insecurity, and the growing power of the commercial determinants of health. Together, these pathways explain how political and economic choices translate into biologically embodied health outcomes over the life course. We illustrate our argument with a case study of austerity. Following Virchow’s insight that politics is medicine “on a large scale”, we conclude that under neoliberalism, health inequalities are inevitable. Addressing them therefore requires public health to confront the political and economic structures that systematically generate stress, insecurity, inequality and commercial harm, rather than relying on downstream or individual‑level interventions.

Citations

• Health Systems as Contested Ground
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(2): e006.     CrossRef

Background
Health outcomes and inequalities are shaped by political processes, yet the vocabulary used to describe this relationship is applied inconsistently and has not been systematically examined. This vocabulary includes “health politics,” “politics of health,” “politics of public health,” “politics of health policy,” and “political determinants of health” (PDoH).
Objectives
To map how “politics” is conceptualized when these focal terms are used across the health and social science literature, and to clarify how PDoH relates to the broader health-politics vocabulary.
Methods
In this scoping review, we searched Scopus, Web of Science, and PubMed for articles published between 1976 and 2025 and conducted a term-in-use analysis of 457 included records (329 using politics-of-X terms; 128 using PDoH). Using directed qualitative content analysis, two independent coders classified the dominant conceptualization of each focal term into seven categories (policy process; governance and accountability; interest group politics; social movements; critical power analysis; political economy and welfare state; and ethics and normative reasoning), with almost perfect inter-rater agreement (screening κ = 0.94; primary-category κ = 0.90).
Results
Conceptual usage was dominated by policy process (31.3%) and critical power analysis (26.9%), which together accounted for 58.2% of records, with the remaining categories comparatively sparse. The politics-of-X and PDoH corpora shared this conceptual core in nearly equal proportion (each ≈ 58%) but differed in emphasis: PDoH was more often framed through critical power analysis and structurally oriented categories (political economy, governance), whereas politics-of-X terms more often invoked actor- and process-centered framings. Multiple correspondence analysis recovered two interpretive axes, contrasting structural/critical with agential/process usage and conceptual with applied usage.
Conclusions
“Health politics” operates not as a single bounded concept but as a label organized around two loosely connected conceptual traditions: an applied, process-centered one and a critical, structurally oriented one. PDoH sits within this structure as a critically and structurally inflected specialization rather than a departure from it. The resulting mid-range typology offers a shared vocabulary for more cumulative research on the political drivers of health.

Citations

• Health Systems as Contested Ground
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(2): e006.     CrossRef

Research on East Asian welfare states has often emphasized regime typologies while paying less attention to the political contestation shaping health policy trajectories. This theoretical/conceptual article develops a historical-institutional framework for understanding Taiwan’s health politics beyond National Health Insurance (NHI). Drawing on official policy documents, legislative materials, ministerial statements, civil society publications, and scholarly literature, the article argues that Taiwan’s health politics is organized by two durable cleavages: the tension between technocratic cost containment and electorally driven expansion, most visible in NHI financing politics, and the tension between public care provision and household-based migrant care labor, most visible in long-term care. Tracing the trajectory from NHI’s establishment in 1995 through LTC 1.0, LTC 2.0, the 2026 launch of LTC 3.0, and the 2024 to 2025 changes to migrant caregiver hiring rules, the article shows that these cleavages tend to generate asymmetric outcomes: incremental expansion, delayed fiscal adjustment, and continued reliance on stratified care labor. By linking long-term care policy to political contestation, labor regulation, and welfare governance, the article contributes to comparative debates on aging, care systems, and welfare state development in East Asia.

Citations

• Health Systems as Contested Ground
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(2): e006.     CrossRef

A key structural characteristic of the Korean medical system is that the public share of total medical expenditure is low, and the provision of medical services relies primarily on the private sector. These structural characteristics emerged within the context of World War II, the end of the war, the Cold War system, and the expansion of global neoliberalism. Even amidst colonialism, authoritarian regimes, and the abuses of development-oriented governments, there were counter-movements that resisted through independence, democratization, and the strengthening of public services. In this process of co-evolution, specific policies related to the healthcare system often became the concrete manifestations of this struggle. The partial achievements attained by civil society and labor movements—such as the establishment of workers’ hospitals, the integration of health insurance, and the prevention of healthcare privatization—were made possible by progress in the broader context of independence and democratization. Currently, the Korean healthcare system is facing three major crises: (1) constant pressure for privatization and commercialization of healthcare services, (2) sustainability of the healthcare system amid rapid aging, and (3) explosive growth of science and technology driven by artificial intelligence (AI) and the resulting weakening of civil, labor, and social rights. The outcome of the new crisis currently facing South Korea’s healthcare system will also be determined by the multilayered political dynamics between dominant and countervailing forces at the global, national, and collective levels. The history of co-evolution between politics and the healthcare system that South Korean society has built thus far will provide useful insights not only for Korea but also for other nations facing similar situations in their efforts to establish better healthcare systems.

Citations

• Health Systems as Contested Ground
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(2): e006.     CrossRef

Background
Japan’s postwar welfare state developed around the universal Statutory Health Insurance System (SHIS), a complex public–private arrangement involving diverse insurers, providers, and government actors. Because most healthcare providers operate outside direct government control, the regulation of healthcare organizations and the setting of SHIS payment rates have remained central concerns in Japanese healthcare politics. However, the diversity of institutional arrangements and policymaking processes across different healthcare policy arenas has received limited systematic attention.
Methods
This paper conducts an institutional analysis of policy documents, media reports, and scholarly literature to examine Japanese healthcare politics over the past three decades.
Results
The paper begins by outlining the institutional structure of the SHIS and the key actors involved. It then examines four major arenas of healthcare policymaking: consensus-building in national councils, biennial revisions of medical fees and drug prices, system-wide health insurance reforms, and healthcare delivery reforms involving complex central–local relations. The analysis further considers how these arenas are affected by recent political transformations. These transformations include stronger political leadership, shifts in party competition, and intensifying conflicts over cost containment and cost-sharing. The analysis also highlights the emerging but uneven influence of patient voices and public opinion; while these forces remain structurally limited overall, they can occasionally prove decisive.
Conclusion
Rather than constituting a single unified process, contemporary healthcare politics in Japan is best understood as a differentiated system in which multiple policy processes coexist across distinct arenas. At the same time, changing political structures are reshaping distributive conflicts—increasingly centered on patient cost-sharing—within a healthcare system historically committed to universal coverage.

Citations

• Health Systems as Contested Ground
  Haejoo Chung, Carles Muntaner
  Health Politics.2026; 1(2): e006.     CrossRef