Table 2 Comparison of selected countries’ contexts

Argentina

Significant economic fluctuations caused three periods of recession: in 1995, between 1999 and 2002, and since 2014.

• A significant increase in unemployment and poverty rates.

• A decrease in the value of the current currency.

Integrated healthcare system

Consists of three main sectors: government, private and social security

[38,39,40,41]

Brazil

Economic turmoil and political instability in 2014.

• Decrease in GDP growth rate.

• Increase in the population below the poverty line and the homeless.

• Reduced access to private insurance.

Integrated healthcare system

Relying on private insurances

[42, 43]

Cuba

US sanctions against Cuba were initiated in 1961 and caused economic shock in 1980.

• Reduction in the import of oil as the main source of energy.

• Decrease in gross domestic product.

• Severe deficit of the government budget.

Relying on primary healthcare and polyclinics that provide comprehensive preventive services and primary care at the local level for individuals and families

Providing free services/socialist/financing on the basis of general taxes

[44,45,46,47,48]

England

The global economic crisis in 2008 led to a loan of 178 billion euros by the British government to prevent the collapse of the banking system. In 2010, the British public sector had a debt of 93 billion euros.

• Decreasing government per capita health spending.

• Annual real expenditure growth of zero during the periods of 2009–2010 and 2014–2015.

National Health System

Providing free services/financing on the basis of general taxes

[49,50,51]

Germany

The global economic crisis in 2008 led to a projected deficit in the GKV health fund.

• Although the GDP per capita decreased in 2009, the country was not greatly affected by the economic shock. Health’s share of government spending from 2009 to 2011 was among the top five European countries.

Provides good access to services with freedom of choice of service provider and low waiting time, which is partly due to good infrastructure and a dense network of outpatient doctors and hospitals and a high level of quality of service provision

Most of its financing from government funds/compulsory social health insurance and participation of the labour market

[52,53,54]

Spain

The impact of the global financial crisis on this country began in 2008.

• Decreasing GDP growth rate and increasing unemployment rate from 2009 to 2013.

• Among the countries of the European Union, it experienced one of the most severe crises and the worst consequences.

A healthcare system that provides a set of healthcare services from the central government and autonomous communities. In this system, responsibility of autonomous communities to plan and manage healthcare centres and service networks

Transforming the health financing system from social security (social insurance system) into a health system with financing based on general taxes

[24, 55,56,57,58,59]