David Pace, at Green Cape, a big Australian long-only fund manager asked me how European governments are responding to the deficit in healthcare strategy. 

I think that, in general terms, governments have not developed coherent strategies to cut costs.  In Southern Europe  cuts have been visted on easy-to-cut private providers. In Romania and Bulgaria governments are moving away from universal public healthcare and demanding that citizens meet some of the costs of treatment.

In the UK, Sweden and Netherlands there are attempts to build markets in healthcare services based on information transparency.  France continues to follow (quite effectively) a top down policy of cutting providsers (public and private) who lack scale volumes. Germany remains deadlocked with no coherent plans at all.

The policymaking community, particularly the academic community, remain opposed to heavy, private sector involvement. I think this is particularly the case in the big NHS countries such as UK, Italy and Spain. Politicians who advocate changes in these countries, therefore, face particular barriers.

Very few countries have a rational, long-term policy. This reflects the fact that healthcare reform remains political dynamite - just look at how the Czech government lost control of all the regions to the left after pushing through measures which mean citizens have to pay a very modest sum to visit a family doctor.

Having said that, in all countries you see similar drivers:

- towards more patient choice (except in Germany)
- the search for information transparency on treatment outcomes and performance
- the creation of a plurality of providers
- a move from inpatient acute to outpatient chronic.

All this should favour the private sector in the long-term.