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Convergence of European healthcare systems: a cluster analysis
Paolo Liberati* 
Article | Year: 2026 | Pages: 167 - 213 | Volume: 50 | Issue: 2 Received: May 21, 2025 | Accepted: February 16, 2026 | Published online: June 5, 2026
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Alber, J., 1995. A framework for the comparative study of social services. Journal of European Social Policy, 5(2), pp. 131-149 [ CrossRef]
Alsasua, J., Bilbao-Ubillos, J. and Olaskoaga, J., 2007. The EU integration process and the convergence of social protection benefits at national level. International Journal of Social Welfare, 16(4), pp. 297-306 [ CrossRef]
Arts, W. and Gelissen, J., 2002. Three worlds of welfare capitalism or more? A state-of-the-art report. Journal of European Social Policy, 12(2), pp. 137-158 [ CrossRef]
Bambra, C., 2005a. Worlds of Welfare and the Health Care Discrepancy. Social Policy and Society, 4(1), pp. 31-41 [ CrossRef]
Bambra, C., 2005b. Health Status and the Worlds of Welfare. Social Policy and Society, 5(1), pp. 53-62 [ CrossRef]
Barbier, J., 2012. Tracing the fate of EU 'social policy': Changes in political discourse from the 'Lisbon Strategy' to Europe 2020. International Labour Review, 151(4), pp. 377-399 [ CrossRef]
Barros, P. P., 2007. The slow and unnoticed changes in the funding mix. Health Economics, 16, pp. 437-440 [ CrossRef]
Bergqvist, K., Yngwe, M. Å. and Lundberg, O., 2013. Understanding the role of welfare state characteristics for health and inequalities - An analytical review. BMC Public Health, 13, 1234, pp. 1-20 [ CrossRef]
Bertin, G., Carrino, L. and Pantalone, M., 2021. Do standard classifications still represent European welfare typologies? Novel evidence from studies on health and social care. Social Science and Medicine, 281, 114086 [ CrossRef]
Bilbao-Ubillos, J., 2023. The Social Dimension of the European Union: A Means to lock out Social Competition? Social Indicators Research, 165, pp. 267-281 [ CrossRef]
Böhm, K. [et al.], 2013. Five types of OECD healthcare systems: Empirical results of a deductive classification. Health Policy, 113(3), pp. 258-269 [ CrossRef]
Braithwaite, J., Travaglia, J. F. and Corbett, A., 2011. Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved? Health Care Analysis, 19, pp. 133-153 [ CrossRef]
Breyer, F. and Lorenz, N., 2020. The 'red herring' after 20 years: ageing and health care expenditures. The European Journal of Health Economics, 22, pp. 661-667 [ CrossRef]
Brick, A. and Connolly, S., 2021. Waiting Times for Publicly Funded Hospital Treatment: How does Ireland Measure Up? The Economic and Social Review, 52(1), pp. 41-52.
Burau, V. and Blank, R.H., 2006. Comparing Health Policy: An Assessment of Typologies of Health Systems. Journal of Comparative Policy Analysis, 8(1), pp. 63-76 [ CrossRef]
Burke, S. [et al.], 2018. Sláintecare – A ten-year plan to achieve universal healthcare in Ireland. Health Policy, 122(12), pp. 1278-1282 [ CrossRef]
Calinski, R. B. and Harabasz, J., 1974. A dendrite method for cluster analysis. Communications in Statistics, 3(1), pp. 1-27 [ CrossRef]
Carreira Da Silva, F., 2017. Welfare State. In: W. Outwhaite and S. Turner, eds. The SAGE Handbook of Political Sociology [ CrossRef]
Castles F. G. and Obinger, H., 2008. Worlds, Families, Regimes: Country Clusters in European and OECD Area Public Policy. West European Politics, 31(1-2), pp. 321-344 [ CrossRef]
Castles, F. G. (ed.), 2007. The Disappearing State? Retrenchment Realities in an Age of Globalization. Cheltenham: Edward Elgar [ CrossRef]
Castles, F. G., 2002. Developing new measures of welfare state change and reform. European Journal of Political Research, 41(5), pp. 613-641 [ CrossRef]
Castles, F. G., 1999. Comparative Public Policy Patterns of Post-War Transformation. Cheltenham: Edward Elgar
Cerami, A., 2010. The Politics of Social Security Reforms in the Czech Republic, Hungary, Poland and Slovakia. In: B. Palier, ed. A Long. Goodbye to Bismarck?: The Politics of Welfare Reform in Continental Europe. Amsterdam: Amsterdam University Press; pp. 233-254 [ CrossRef]
Daly, M., 1997. Welfare states under pressure: cash benefits in European welfare states over the last ten years. Journal of European Social Policy, 7(2), pp. 129-146 [ CrossRef]
Danforth, B., 2014. Worlds of welfare in time: A historical reassessment of the three-world typology. Journal of European Social Policy, 24(2), pp. 164-182 [ CrossRef]
De Simone, E., Gaeta, G. L. and Ercolano, S., 2012. Exploring Public Social Expenditure Trends in the Globalization Era. European Research Studies, 15(1), pp. 23-42 [ CrossRef]
Den Teuling, N. G. P., Pauws, S. C. and van den Heuvel, E. R., 2021. A comparison of methods for clustering longitudinal data with slowly changing trends. Communications in Statistics - Simulation and Computation, 52(3), pp. 621-648 [ CrossRef]
Dubas-Jakóbczyk, K. [et al.], 2020. Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis. Health Policy, 124(4), pp. 368-379 [ CrossRef]
Duda, R. O. and Hart, P. E., 1973. Pattern Classification and Scene Analysis. New York: John Wiley and Sons.
Emmenegger, P. [et al.], 2015. Three Worlds of Welfare Capitalism - The making of a classic. Journal of European Social Policy, 25(1), pp. 3-13 [ CrossRef]
Ermakoff, I., 2019. Causality and history: Modes of causal investigation in historical social sciences. Annual Review of Sociology, 45(1), pp. 581-606 [ CrossRef]
Esping-Andersen, G., 1990. The Three Worlds of Welfare Capitalism. Princeton: Princeton University Press.
Everitt, B. S. [et al.], 2011. Cluster Analysis. 5th ed. London: Wiley [ CrossRef]
Ferge, Z., 1997. The Changed Welfare Paradigm: The Individualization of the Social. Social Policy and Administration, 31(1), pp. 20-44 [ CrossRef]
Ferragina, E. and Seeleib-Kaiser, M., 2011. Welfare regime debate: past, present, futures? P olicy and Politics, 39(4), pp. 583-611 [ CrossRef]
Filipovic, H. and Dobrotic, I., 2022. Eastern European Welfare States. In: B. Greve, ed. Handbook of Contemporary Welfare States. Berlin: De Gruyter, pp. 119-134 [ CrossRef]
Fosse E., 2011. Different welfare states different policies? An analysis of the substance of national health promotion policies in three European countries. International Journal of Health Services, 41(2), pp. 255-273 [ CrossRef]
Freeman, R., 1999. Institutions, states and cultures: health policy and politics in Europe. In: J. Clasen, ed. Comparative Social Policy. Oxford: Blackwell.
Giaimo, S. and Manow, P., 1999. Adapting the Welfare State - The case of Health Care Reform in Britain, Germany, and the United States. Comparative Political Studies, 32(8), pp. 967-1000 [ CrossRef]
Gilardi, F., Füglister, K. and Luyet, S., 2009. Learning From Others - The Diffusion of Hospital Financing Reforms in OECD countries. Comparative Political Studies, 42(4), pp. 549-573 [ CrossRef]
Giuliani, A. and Vici, A., 2024. On the (Apparently) Paradoxical Role of Noise in the Recognition of Signal Character of Minor Principal Components. Stats, 7(1), pp. 54-64 [ CrossRef]
Goodin, R. E. and Le Grand, J., 1987. Not Only the Poor - The Middle Classes and the Welfare State. London: Routledge.
Gough, I., 2001. Social assistance regimes: a cluster analysis. Journal of European Social Policy, 11(2), pp. 165-170 [ CrossRef]
Hall, P. A. and Soskice, D. (ed.). Varieties of capitalism: the institutional foundations of comparative advantage. Oxford: Oxford Academic Press [ CrossRef]
Hemerijck, A., 2012. When Changing Welfare States and the Eurocrisis Meet. Sociologica, 1(1), pp. 1-58.
Higgins, J., 1981. States of Welfare - Comparative Analysis in Social Policy. Oxford: Basil Blackwell ; Martin Robertson.
Huber, E. and Stephens, J., 2001. Development and Crisis of the Welfare State: Parties and Policies in Global Markets. Chicago: University of Chicago Press [ CrossRef]
Jensen, C., 2008. Worlds of welfare services and transfers. Journal of European Social Policy, 18(2), pp. 151-162 [ CrossRef]
Joumard, I., André, C. and Nicq, C., 2010. Health care systems: efficiency and institutions. Economics Department Working Papers, No. 769 [ CrossRef]
Kangas, O., 1994. The politics of social security: on regressions, qualitative comparisons, and cluster analysis. In: T. Janoski and A. M. Hicks. The Comparative Political Economy of the Welfare State. Cambridge: Cambridge University Press, pp. 346-364.
Kasza, G. J., 2002. The Illusion of Welfare 'Regimes'. Journal of Social Policy, 31(2), pp. 271-287 [ CrossRef]
Kaufman, L. and Rousseeuw, P. J., 1990. Finding Groups in Data. An Introduction to Cluster Analysis. New York: John Wiley and Sons [ CrossRef]
Kautto, M., 2002. Investing in services in West European welfare states. Journal of European Social Policy, 12(1), pp. 53-65 [ CrossRef]
Kringos, D. S. [et al.], 2013. The strength of primary care in Europe: an international comparative study. British Journal of General Practice, 63(616), e742-e750 [ CrossRef]
Kuitto, K., 2011. More than just money: Patterns of disaggregated welfare expenditure in the enlarged Europe. Journal of European Social Policy, 21(4), pp. 348-364 [ CrossRef]
Kuitto, K., 2016. Post-Communist welfare states in European context: Patterns of welfare policies in Central and Eastern Europe. Cheltenham: Edward Elgar.
Lamping, W. and Rüb, F. W., 2004. From the Conservative Welfare State to an Uncertain Else: German Pension Politics in Comparative Perspective. Policy and Politics, 32(2), pp. 169-191 [ CrossRef]
Lee, J. Y. [et al.], 2016. Trajectories of cigarette smoking beginning in adolescence predict insomnia in the mid thirties. Substance Use and Misuse, 51(5), pp. 616-624 [ CrossRef]
Leiter, A. M. and Theurl, E., 2012. The convergence of health care financing structures: empirical evidence from OECD-countries. The European Journal of Health Economics, 13(1), pp. 7-18 [ CrossRef]
Losada, A. and Ares, C., 2021. The resistance of the four European worlds of welfare from the births of the euro. Brazilian Journal of Political Economy, 41(2), pp. 271-291 [ CrossRef]
Lu, Z., 2024. Clustering Longitudinal Data: A Review of Methods and Software Packages. International Statistical Review, 93(3), pp. 425-458 [ CrossRef]
Lundberg O. [et al.], 2015. Welfare State and Health Inequalities. Canadian Public Policy, 41(Sip. 2) [ CrossRef]
Milligan, G. W. and Cooper, M. C., 1985. An Examination of Procedures for Determining the Number of Clusters in a Data Set. Psychometrika, 50(2), pp. 159-179 [ CrossRef]
Minas, C., Jacobson, D. and McMullan, C., 2014. Welfare regime, welfare pillar and Southern Europe. Journal of European Social Policy, 24(2), pp. 135-149 [ CrossRef]
Moran, M., 2000. Understanding the Welfare State: The Case of Health Care. British Journal of Politics and International Relations, 2(2), pp. 135-160 [ CrossRef]
Movahed, M., 2023. Varieties of capitalism and income inequality. International Journal of Comparative Sociology, 64(6), pp. 621-657 [ CrossRef]
Musgrove, P., 2003. Judging health systems: reflections on WHO’s methods. The Lancet, 361(9371), pp. 1817-1820 [ CrossRef]
Obinger, H. and Wagschal, U., 2001. Families of nations and public policy. West European Politics, 24(1), pp. 99-114 [ CrossRef]
OECD, 2018. Health at a glance: Europe 2018: State of health in the EU cycle. Paris: OECD [ CrossRef]
OECD, 2025a. Health at a Glance 2025. Paris: OECD [ CrossRef]
OECD, 2025b. How Do Health System Features Influence Health System Performance? Paris: OECD [ CrossRef]
Palier, B., 2010. Ordering Change: Understanding the 'Bismarckian' Welfare Reform Trajectory. In: B. Palier, ed. A Long Goodbye to Bismarck? Amsterdam: Amsterdam University Press, pp. 19-44 [ CrossRef]
Panic, M., 2003. Globalization and national economic welfare. London: Palgrave; MacMillan [ CrossRef]
Pestieau, P. and Lefebvre, M., 2018. The Welfare State in Europe: Economic and Social Perspectives. 2nd ed. Oxford: Oxford University Press [ CrossRef]
Pierson, C., 2006. Beyond the Welfare State - The new political economy of welfare. Cambridge: Polity Press.
Pierson, P., 2004. Politics in Time - History, Institutions, and Social Analysis. Princeton and Oxford: Princeton University Press [ CrossRef]
Pinker, R., 1971. Social Theory and Social Policy. London: Heinemann.
Ploug, N., 1995. The welfare state in liquidation? International Social Security Review, 48(2), pp. 61-71 [ CrossRef]
Polin, K. [et al.], 2021. Top-Three" health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview. Health Policy, 125(7), pp. 815-832 [ CrossRef]
Powell, M. and Barrientos, A., 2004. Welfare regimes and the welfare mix. European Journal of Political Research, 43(1), pp. 83-105 [ CrossRef]
Powell, M., Yörük, E. and Bargu, A., 2019. Thirty years of the Three Worlds of Welfare Capitalism: A review of reviews. Social Policy Administration, 54(1), pp. 60-87 [ CrossRef]
Ranci, C. and Pavolini, E., 2015. Not all that glitters is gold: Long-term care reforms in the last two decades in Europe. Journal of European Social Policy, 25(3), pp. 270-285 [ CrossRef]
Reibling, N., 2010. Healthcare systems in Europe: towards an incorporation of patient access. Journal of European Social Policy, 20(1), pp. 5-18 [ CrossRef]
Reibling, N., Ariaans, M. and Wendt, C., 2019. Worlds of Healthcare: A Healthcare System Typology of OECD Countries. Health Policy, 123(7), pp. 611-620 [ CrossRef]
Rothgang, H. [et al.], 2010. The State and Healthcare: Comparing OECD Countries. London: Palgrave; MacMillan [ CrossRef]
Rothgang, H., 2021. Health. In: D. Béland [et al.], eds. The Oxford Handbook of the Welfare State. 2nd ed. Oxford: Oxford University Press, pp. 506-523 [ CrossRef]
Ruggles, P. and O'Higgins, M., 1987. Retrenchment and the New Right: A Comparative Analysis of the Impacts of the Thatcher and Reagan Administration. In: M. Rein, G. Esping-Andersen and L. Rainwater, eds. Stagnation and Renewal in Social Policy - The Rise and Fall of Policy Regimes. London: M.E. Sharpe Inc., pp. 160-190.
Saint-Arnaud, S. and Bernard, P., 2003. Convergence or resilience? A hierarchial cluster analysis of the welfare regimes in advanced countries. Current Sociology, 51(5), pp. 499-527 [ CrossRef]
Shalev, M., 2007. Limits and alternatives to multiple regression in comparative research. Comparative Social Research, 24, pp. 261-308.
Sorenson, C., Drummond, M. and Kahn, B. B., 2013. Medical technology as a key driver of rising health expenditures: disentangling the relationship. ClinicoEconomics and outcomes research, 5, pp. 223-234 [ CrossRef]
Sowula, J. [et al.], 1993. Against Positive Rights Feature. East European Constitutional Review, 35, pp. 35-38.
Sowula, J. [et al.], 2023. The end of welfare states as we know them? A multidimensional perspective. Social Policy Administration, 58(5), pp. 785-799 [ CrossRef]
Swank, D., 2002. Global Capital, Political Institutions, and Policy Change in Developed Welfare States. Cambridge: Cambridge University Press [ CrossRef]
Szebehely, M. and Meagher, G., 2017. Nordic eldercare - Weak universalism becoming weaker? Journal of European Social Policy, 28(3), pp. 294-308 [ CrossRef]
Taylor Brown, C. and Ben Brik, A., 2024. Welfare regime typologies: The six worlds of social inclusion. Journal of International and Comparative Social Policy, 40(1), pp. 1-23 [ CrossRef]
Taylor-Gooby, P., 1996. The Future of Health Care in Six European Countries: The Views of Policy Elites. International Journal of Health Policy, 26(2), pp. 203-219 [ CrossRef]
Taylor-Gooby, P., Leruth, B. and Chung, H. (eds.), 2017. After Austerity: Welfare State Transformation in Europe after the Great Recession. Oxford: Oxford University Press [ CrossRef]
The Lancet Regional Health – Europe, 2025. Ireland: Europe's outlier in primary health care. The Lancet Regional Health - Europe, 50, 101253 [ CrossRef]
Thomas, S. [et al.], 2021. Sláintecare implementation status in 2020: Limited progress with entitlement expansion. Health Policy, 125(3), pp. 277-283 [ CrossRef]
Tiemann, O., Schreyogg, J. and Busse, R., 2012. Hospital ownership and efficiency: A review of studies with particular focus on Germany. Health Policy, 104(2), pp. 163-171 [ CrossRef]
Tine, R. [et al.], 2022. Revisiting the Nordic long-term care model for older people - still equal? E uropean Journal of Ageing, 19, pp. 201-210 [ CrossRef]
Titmuss, R. M., 1974. Social Policy. London: Allen and Unwin.
Vaughan-Whitehead, D., 2017. The European Social Model in times of crisis: An overview. In: D. Vaughan-Whitehead, ed. The European Social Model in Crisis - Is Europe Losing Its Soul? Cheltenham: Edward Elgar, pp. 1-65.
Walsh, B. [et al.], 2022. The impact of inpatient bed capacity on length of stay. The European Journal of Health Economics, 23, 499-510 [ CrossRef]
Wendt, C. and Kohl, J., 2010. Translating Monetary Inputs into Health Care Provision: A Comparative Analysis of the Impact of Different Modes of Public Policy. Journal of Comparative Policy Analysis: Research and Practice, 12(1), pp. 11-31 [ CrossRef]
Wendt, C., 2009. Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare. Journal of European Social Policy, 19(5), pp. 432-445 [ CrossRef]
Wendt, C., 2014. Changing Healthcare System Types. Social Policy and Administration, 48(7), pp. 864-882 [ CrossRef]
Weybright, E. H. [et al.], 2016. Trajectories of adolescent substance use development and the influence of healthy leisure: A growth mixture modeling approach. Journal of Adolescence, 49(1), pp. 158-69 [ CrossRef]
WHO, 2000. The World Health Report 2000 - Health systems: Improving performance. Geneva: World Health Organization.
Whyte, R., Connolly, S. and Wren, M., 2020. Insurance status and waiting times for hospital-based services in Ireland. Health Policy, 124(11), pp. 1174-1181 [ CrossRef]
Wilensky, H. and Lebeaux, C., 1965. Industrial Society and Social Welfare. New York: Free Press.
Wilsford, D., 1994. Path Dependency, or Why History Makes It Difficult but Not Impossible to Reform Health Care Systems in a Big Way. Journal of Public Policy, 14(3), pp. 251-283 [ CrossRef]
Witt, M. [et al.], 2018. Mapping the business systems of 61 major economies: a taxonomy and implications for varieties of capitalism and business systems research. Socio-Economic Review, 16(1), pp. 5-38 [ CrossRef]
Zhou, J., Zhang, Y. and Tu, W., 2023. clusterMLD: An efficient hierarchical clustering method for multivariate longitudinal data. Journal of Computational and Graphical Statistics, 32(3), pp. 1131-1144 [ CrossRef]
Zweifel, P., Steinmann, L. and Eugster, P., 2005. The Sisyphus Syndrome in Health Revisited. International Journal of Health Care Finance and Economies, 5(2), pp. 127-145 [ CrossRef]
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