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Professor Elias Mossialos

Elias Mossialos is Brian Abel-Smith Professor of Health Policy at the Department of Social Policy at the London School of Economics and Political Science, and Director of LSE Health. His research interests concentrate on health policy relating to health care systems. His particular focus is European and comparative health systems and policy, addressing questions related to funding health care, private health insurance, pharmaceutical policies, the impact of EU law on health care systems, and access to medicines in developing countries. His work has been translated into Japanese, Russian, Greek and Spanish. He is internationally recognised for his comparative work on health care financing and his research on EU law and governance.

He is currently examining approaches to stimulating research for neglected diseases based on the concept of a financial call option. He is also analysing incentives to address the need for sufficient investment in the development of antibiotics in order to meet changing medical needs. He has more than 200 publications, including books, book chapters and articles in peer-review journals in the fields of economics, political science, public policy and health policy.

Professional honours and awards

In 2010 he was awarded the Andrija Stampar medal by the Association of Schools of Public Health in Europe (ASPHER) and the European Public Health Association (EUPHA), for contributions to European public health. He was the 2002 and 2007 recipient of the Baxter Award from the European Health Management Association for the best publication in health policy and management in Europe and received the Certificate of Distinguished Submission for the Baxter Award in 2000. In 2002 he received a Commended Prize by the BMA Medical Book Competition. In 2009, under his directorship, LSE Health and Social Care was honoured with the prestigious Queen's Anniversary Prize for Higher and Further Education, which is awarded biennially in recognition of outstanding achievement and excellence in UK universities and colleges. Uniquely in the field of education, the Prize sits within the national honours system.

Professor Mossialos is a Fellow of the Faculty of Public Health (FFPH) and Fellow of the Royal Colleges of Physicians of London and Edinburgh, and Honorary Consultant in Public Health with the South East London NHS Strategic Health Authority. He is an Honorary Professor at the University of Copenhagen, the London School of Hygiene & Tropical Medicine, and L'Ecole des Hautes Etudes en Santé Publique in France. He is also a member of ASPHER's Honours Committee, the World Health Organization’s (WHO) European Advisory Committee on Health Research and the Access to Medicine Index’s Expert Review Committee.

Editorial positions

Professor Mossialos edits the Health Economics, Policy and Management book series published by Cambridge University Press and co-edits another book series published by Open University Press on Health Care Systems. He is co-editor in chief of Health Economics, Policy and Law, a peer-review journal published by Cambridge University Press, and editor in chief of the Health Systems in Transition reports published by WHO. He also chairs the editorial board of the journal Globalization and Health. In 1995 he founded Eurohealth, a quarterly health policy journal, to cover the middle ground between academic scholarship and policy-making. 

Policy involvement and impact

Professor Mossialos has been an active participant in policy debates, advising the World Health Organization, the European Parliament, the European Commission, the World Bank, the UK Office of Fair Trading, Ministries of Health and Social Affairs in Belgium, Brazil, China, Cyprus, Finland, Greece, Ireland, Kazakhstan, Russia, Slovenia, South Africa, Spain and Sweden, and health insurance funds in Austria, Croatia, France, Hungary and South Korea. He was a member of the management board of the European Medicines Agency (2000-2003) and contributed to the work of the International Forum on 'Common access to health care services' co-ordinated by the health ministers of Sweden, the UK and New Zealand. His advisory activities have included a number of key areas. 

a) Pharmaceutical policy

In 1998, Professor Mossialos was invited by the Russian government and the Russian State Duma to review pharmaceutical policy in Russia during the economic crisis. His recommendations led to significant savings for the government, enabling it to finance additional pharmaceutical care.

In 2007 he was invited by the Finnish government to review pharmaceutical policies in Finland. His review recommended stronger incentives for doctors and pharmacists to prescribe and dispense appropriate and good quality medicines, and policies to improve patient information and resource allocation. Most of the report's recommendations were implemented and have led to significant improvements in pharmaceutical care. The report contributed to the formulation of the Medicines Policy 2020 document jointly adopted by the government and the pharmaceutical industry, which outlines the joint medicine policy perspectives of the social welfare and healthcare authorities and industry stakeholders in the coming decade.  A new centralised agency (the Finnish Medicines Agency, www.fimea.fi|) has been established to carry out cost-effectiveness analyses of pharmaceuticals, conduct research and development related to medicines supply, and disseminate information on rational prescribing practices.

In 2009 Professor Mossialos produced a major report on antibiotics for the 2009 Swedish Presidency of the Council of the European Union. The report considered how the lack of new antibiotics on the market forces physicians to prescribe a limited set of antibiotics, increasing the risks of antibiotic resistance, which some argue is a growing worldwide problem, and proposed new incentive mechanisms based on a call options model to stimulate research and development. The research triggered two main impacts: a recommendation from the Swedish government in 2009 to the Council of the European Union (EU) to debate and issue a decision on antibiotics development in 2010; and a proposal by the Swedish government, following discussion with US government officials in December 2009, to establish a transatlantic (US-EU) commission on antibiotics research and to push for US legislation.

b) Health insurance policy and health systems

Professor Mossialos has twice been invited by the Belgian government (in 2001 and 2008) to undertake ground-breaking analysis of the impact of EU law and governance on health systems. The most recent analysis was presented at a high-level conference in Brussels in 2008 attended by ministers of health from Belgium, Germany, Spain, Hungary and Luxembourg. This work has made a significant contribution to raising awareness among policy makers of the often subtle but important ways in which EU law can affect national autonomy in the area of health care.

He has also advised the Austrian Association of Health Insurance Funds on physician incentives, quality of health care and pharmaceutical policies, and completed a review of public health policies in Austria in 2010.

In November 2007 he gave the keynote speech at a conference organised by the Korean Ministry of Health and the Korean Health Review Agency to celebrate the 30th anniversary of the establishment of social health insurance in Korea. In December 2007 he advised the government of China on health insurance reforms and coverage decisions and in February 2008 Professor Mossialos advised the Prime Minister and several ministers of the Republic of Kazakhstan on social policy developments (higher education, health and social assistance reforms).

His work (with Sarah Thomson) on private health insurance and health system financial sustainability has influenced debate on the interaction between public and private finance in EU health systems among several European Commission directorates (Employment and Social Affairs, Internal Market, Competition and Sanco) and fed into the work of the European Parliament's Committee on Employment and Social Affairs and the EC's Social Protection Committee.

In 2008 his work in health policy formed the centre-piece of a high-level symposium for US policy-makers in Washington DC following the presidential elections in 2008. This was attended by senior US government officials, advisers to the transition team of then President-elect Barak Obama and several ministers of health from other countries. Subsequently, he was invited to organise the Commonwealth Fund's International Symposium on Health Systems (attended by several Ministers of Health) in Washington, DC in November 2010.

Research centres and major research initiatives

LSE Health

In 1996 Professor Mossialos founded LSE Health, which is currently LSE's largest research centre with 60 staff working on a wide range of trailblazing research. In the 2008 UK Research Assessment Exercise (RAE), the Centre's staff accounted for 25% of the submission by the LSE's Department of Social Policy, which has ranked first in its field in the UK in equivalent evaluations since 1996.

The Centre's dedication to combining technical competence with policy mindedness runs through its research, partnerships and networks. It is also an essential element of its postgraduate programmes, which train future generations of leaders in health care.

The Centre also has dedicated resources to foster the training of young researchers. Its reserve fund of approximately £1.5 million is used to fund doctoral and post-doctoral students and since 2004, the Centre has contributed a further £700,000 of its own funds to support its PhD students. In 2009 the LSE's Research Committee highlighted the Centre's PhD programme and postdoctoral support systems as "exemplary".

The European Observatory on Health Systems and Policies

In 1998, Professor Mossialos co-founded the European Observatory on Health Systems and Policies, a major health policy research and knowledge transfer programme. The Observatory is a partnership between the World Health Organization (Regional Office for Europe), the World Bank, the European Investment Bank, the Governments of Belgium, Finland, Ireland, The Netherlands, Norway, Slovenia, Spain and Sweden, the French National Health Insurance Fund (Caisse nationale de l'assurance maladie des travailleurs salariés), the Veneto Region of Italy, LSE and LSHTM.  He is currently Co-Director of the Observatory.

The Observatory supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe. The Observatory makes a key contribution to cross-national comparative analysis in two ways: it lays the groundwork for others to engage in comparative analysis and it produces award-winning comparative analyses of its own. The Observatory's country health system reports are internationally recognised for their innovative approach, their rigour and their comprehensive scope. The Observatory also produces policy briefs, which summarise key research findings in an accessible format to inform policy-makers. An important part of the Observatory's work is organising 'policy dialogues' with ministries of health in Europe. These bring together high-level policy-makers to debate specific policy issues with international experts. The Observatory is widely acknowledged as a unique success story in knowledge development and transfer and a potential model to aid national decision-making in low- and middle-income countries.

The European Observatory on the Social Situation (2005-2012)

Professor Mossialos is also Co-Director of the European Observatory on the Social Situation, set up by the European Commission in 2005 to analyse social and demographic trends. His LSE-based research team reports on key health and social care policy challenges, and produces research and policy briefs to assist the Commission. His work on a major EU project on health status and living conditions also feeds into the work of the EC's Social Protection Committee and the development of health system performance indicators.

Teaching contributions and innovations

In 1999, Professor Mossialos established the MSc in International Health Policy at LSE, which has attracted high quality students from more than 90 countries. In 2009 he established a modular MSc in Health Economics, Policy and Management, Europe's only modular MSc in the field. The MSc has been designed to meet the needs of mid-career professionals who seek formal qualifications in health economics, policy and management but do not have the flexibility to participate in a traditional MSc programme.

His teaching at the LSE reflects his research interests as outlined above. Professor Mossialos teaches the following courses at master’s level:

SA 407 Financing health care
SA 4D4 Measuring health systems performance
SA 427 Pharmaceutical Economics and Policy

Recent Keynote and distinguished lectures

  • Health policy-innovating for longevity, Swiss Re Annual Conference, Zurich, 22 October 2012
  • Bending the cost curve: Priorities and strategies in high income countries for containing costs, 15th International Symposium on Health Care Policy, The Commonwealth Fund, Washington D.C., 14 November 2012
  • The role and implementation of HTA in CEE countries, National Assembly, Sofia, Bulgaria, 29 November 2012
  • Health Sector Performance, The 3rd Lecture of the Supreme Health Council, Qatar, Distinguished Lecture Series, Doha, 22 January 2013
  • New contractual models for coordinating outpatient chronic care, Caisse Nationale de l’Assurance Maladie (French National Health Insurance Fund), Paris, 31 January 2013
  • The affordability of the health care system: looking into the future, European Society of Cardiology, 20th Anniversary Conference, Nice, 6 March 2013

Activities in Greek politics and policy

a) Government activities

From 2009 - 2012 Professor Mossialos was an MP in the Greek Parliament. He has served as a member of four Parliamentary Select Committees (Social Affairs, Educational Affairs, Defence and Foreign Affairs and European Affairs) and chaired the Parliament's Special Permanent Committee on Monitoring the Social Security System (2010-11).

He was appointed Minister of State in 2011. As a minister he participated in all major negotiations in Brussels, Berlin and Paris on restructuring the Greek debt and presented a comprehensive plan on the reorganisation of Greek state TV and radio channels.  This plan included the modernisation, downsizing and reorganisation of public broadcasting services, and led to the closure of two unproductive organisations which had been funded by the tax-payer, the only state enterprises to have been closed by the Government in the last few years. However, the plan was not fully implemented due to trade union opposition and lack of parliamentary and government support.

While in office in 2011 Professor Mossialos managed to reduce the budget of his Ministry by 40% and of his personal ministerial office by 70%. He was the only MP in modern Greek parliamentary history to decline most parliamentary privileges (including a state car, free travel and phone call expenses, office equipment and the secondment of civil servants to support his work); he also declined to receive the special pension contributions for MPs.

b) Civil engagement

Professor Mossialos is an honorary member of the coordinating board of the Citizens’ Union Paremvassi and one of the founders of the citizens’ movement Dynamic Greece, an independent organization established in 2012 to promote evidence-based policy making.

c) Health policy

Nearly two decades ago, Professor Mossialos was the coordinator of the International Committee of Experts (chaired by the late Professor Brian Abel-Smith) invited by the then Prime Minister Andreas Papandreou to review the Greek health system in 1994. The Committee produced an influential report on reorganising the Greek National Health System (B. Abel-Smith, J. Calltorp, M. Dixon, Ad. Dunning, R. Evans, W. Holland, B. Jarman, E. Mossialos, Report on the Greek Health Services. Athens: Ministry of Health, June 1994).

He also made a major contribution to the Greek government's White Paper on the decentralisation of health services and development of regional health authorities in 2001. This led to services being better able to respond to local patient needs.

Professor Mossialos was a member of the board of the Hellenic National Medicines Agency between 2000 and 2002.

d) Research centres and initiatives

Professor Mossialos was the coordinator of the LSE Fundraising Committee (1993-96) to establish the Hellenic Observatory and the Eleftherios Venizelos Chair of Contemporary Greek Studies at the LSE European Institute. He served as the Acting Director of the Hellenic Observatory between 1996 and 1998. He also co-organised two important LSE conferences on Greece in the 1990s (Greece: Prospects for Modernisation in 1994 and The Contribution of a Changing Greece to the European Union: The Dynamics of a Complex Relationship in 1998).

Current research students

  • Lucia Kossarova (Measuring health system performance in Slovakia)
  • Philipa Mladovsky  (Analysing the socio-political determinants of social health insurance in Ghana)
  • Huseyin Naci (Appropriateness and Quality of Care: Developing Methodologies and Indicators for Assessing the Quality of Medication Use in Selected European Countries)
  • Corinna Sorenson (Toward Effective Health Technology Regulation)

Thesis titles of recent PhD students

  • Examining aspects of equity in Canada's health system
  • Voluntary health insurance and health system performance in the European Union
  • 'The New NHS': Financial Incentives for Quality?
  • Decision-making under risk. The case of adolescent smoking
  • Non-adherence to medication: The impact of the doctor-patient relationship
  • General Practitioners' prescribing decision-making: the case of proton pump inhibitors in France
  • The politics of health insurance reform in Korea: institutions, policy networks and policy outputs 
  • Welfare arrangements, safety nets and familial support for the elderly in Portugal
  • The impact of differing regulatory frameworks on post-patent pharmaceutical markets in the UK, US and Germany (1990-1997)
  • Regulating under constraint: the case of EU pharmaceutical policy
  • An analysis of the government-industry relationship in the British pharmaceutical price regulation scheme

Selected publications

  1. Thomson S, Mossialos E. (eds). Private health insurance: history, politics, performance. Cambridge: Cambridge University Press, 2013.
  2. Mossialos E, Naci H, Courtain E. Expanding the role of community pharmacists: Policymaking in the absence of policy-relevant evidence? Health Policy (2013, in press)
  3. Kossarova L., Holland W., Mossialos E. of health system performance in the Czech Republic and Slovakia between 1971 and 2008. Health Policy and Planning (2013, in press). 
  4. Stabile M, Thomson S, Allin S, Boyle S, Busse R, Chevreul K, Marchildon G, Mossialos E. Containing health care costs in high-income countries: evidence from four nations. Health Affairs (2013, in press)
  5. Mossialos E, Lear J. Balancing economic freedom against social policy principles: EC competition law and national health systems. Health Policy 2012;106(2): 127-138. 
  6. Winter H.S., Mossialos E.,  Naci H., Chandra A., Salojee H., Yamashiro Y., Bhutta Z.A., Uauy R., Corvalan C. The economics of health care delivery. Journal of Paediatric Gastroenterology and Nutrition, 2012;55 (5): 482-488.
  7. Rudisill C., Costa-Font J., Mossialos E. Behavioral adjustment to avian flu in Europe during spring 2006: the roles of knowledge and proximity to risk, Social Science and Medicine 2012; 75 (8):1362-1371. 
  8. Morel CM, McGuire A, Mossialos E. The level of income appears to have no consistent bearing on pharmaceutical prices across countries. Health Aff (Millwood). 2011 Aug;30(8):1545-52. 
  9. Boluarte T. A., Mossialos E., Rudisill C. The impact of alcohol policies across Europe on young adults' perceptions of alcohol risks. CESifo economic studies, 2011;57 (4): 763-788
  10. Sorenson C, Naci H, Cylus J, Mossialos E. Evidence of comparative efficacy should have a formal role in European drug approvals. BMJ. 2011;343:d4849. doi: 10.1136/bmj.d4849. 
  11. Mossialos E., Permanand P., Baeten R., Hervey T.H. (eds). Health Systems Governance in Europe: The Role of EU Law and Policy. Cambridge: Cambridge University Press, 2010. 
  12. Smith P.C., Mossialos E., Papanicolas I., Leatherman S.(eds). Performance Measurement for Health System Improvement: Experiences, Challenges and Prospects. Cambridge: Cambridge University Press, 2010. 
  13. Mossialos E, Morel CM, Edwards S, Berenson J, Gemmill-Toyama M, Brogan D. Policies and Incentives for Promoting Innovation in Antibiotic Research. Copenhagen: World Health Organization, 2010
  14. Thomson S., Foubister T., Mossialos E. Can user charges make health care more efficient? BMJ 2010; 341:c3759. 
  15. Hernandez-Quevedo C., Masseria C., Mossialos E. Methodological issues in the analysis of the socioeconomic determinants of health using EU-SILC data. Luxembourg: Eurostat, 2010. 
  16. Hernandez-Quevedo C., Masseria C., Mossialos E. Analysing the socioeconomic determinants of health in Europe: new evidence from the EU-SILC. Luxembourg: Eurostat, 2010. 
  17. Morel CM, Mossialos E. Stoking the antibiotic pipeline. BMJ. 2010 May 18;340:c2115. 
  18. Costa-Font J., Mossialos E., Rudisill C. Optimism and the perceptions of new risks. Journal of Risk Research 2009;12(1):27-41. 
  19. Allin, S., Masseria, C., Mossialos, E. Measuring Socioeconomic Differences in Use of Health Care Services by Wealth Versus by Income. American Journal of Public Health, 2009;99(10):1849-1855. 
  20. Mossialos E., Srivastava D. Pharmaceutical policies in Finland: Challenges and opportunities. Ministry of Health and Social Affairs (Finland) and European Observatory on Health Systems and Policies. Copenhagen: World Health Organization, 2008. 
  21. Mossialos E., Rudisill C. Knowledge about Avian Influenza in the European Region. Emerging Infectious Diseases 2008;14(12):1956-57. 
  22. Mladovsky P., Mossialos E. A Conceptual Framework for Community-Based Health Insurance in Low-Income Countries: Social Capital and Economic Development, World Development 2008;36(4):590-607. 
  23. Costa-Font J., Rudisill C., Mossialos E. Attitudes as an Expression of Knowledge and 'Political Anchoring': The Case of Nuclear Power and Radioactive Waste in the UK. Risk Analysis 2008;28(5):1273-1288. 
  24. Mossialos E., Costa-Font J., Rudisill, C. Does organ donation legislation affect individuals' willingness to donate their own or their relative's organs? Evidence from European Union survey data. BMC Health Services Research 2008;8:48doi. 
  25. Gemmil M., Thomson S., Mossialos E. What impact do prescription drug charges have on equity and efficiency? Evidence from high-income countries. International Journal for Equity and Health 2008;7:12. 
  26. Hirte L., Nolte E., Mossialos E., McKee M. The changing regional pattern of ischaemic heart disease mortality in southern Europe: still health but uneven progress. J Epidemiol Community Health 2008;62:e4. 
  27. Mladovsky P., Mossialos E., McKee M. Improving access to research data in Europe. BMJ 2008;336:287-288. 
  28. Thomson S, Mossialos E. Regulating private health insurance in the European Union: the implications of single market legislation and competition policy. Journal of European Integration 2007;29(1): 89-107. 
  29. Costa-Font J, Mossialos E. Are Perceptions of Risk and Benefits of Genetically Modified Food Independent? Food Quality and Preference 2007;18(2):173-182. 
  30. Mossialos E., D Brogan D. T Walley T. Pharmaceutical pricing in Europe: Weighing up the Options. International Social Security Review 2006;59(3):3-25.
  31. Thomson S., E Mossialos E. Choice of public or private health insurance: learning from the experience of Germany and the Netherlands. Journal of European Social Policy 2006;16(4): 315-327.
  32. Brogan D., E Mossialos E. Applying the Concepts of Financial Options to Stimulate Vaccine Development. Nature Reviews: Drug Discovery 2006;5:641-647.
  33. Al-Moosa S, Allin S, Jemiai N, Al-Lawati J, Mossialos E, Diabetes and urbanization in the Omani population: an analysis of national survey data. Population Health Metrics, 2006; 24;4(1):5.
  34. Permanand G, Mossialos E. Constitutional asymmetry and pharmaceutical policy-making in the European Union. Journal of European Public Policy 2005;12(4):687-609.
  35. Walley T, Mrazek M, Mossialos E. Regulating Pharmaceutical Markets: improving efficiency and controlling costs in the UK. International Journal in Health Planning and Management 2005;20(4):375-98.
  36. Mossialos E, Allin S, Davaki K. Analysing the Greek health system: a tale of fragmentation and inertia. Health Economics 2005;14(S1):S151-S168.
  37. Foubister T, Thomson S, Mossialos E, McGuire A. Private medical insurance in the United Kingdom. Copenhagen: Copenhagen: World Health Organization, 2005.
  38. Allin S, Davaki K, Mossialos E. Informal Payments in Central and Eastern Europe and the Commonwealth of Independent States. In Transparency International. Global Corruption Report 2006. London: Pluto.
  39. Petmesidou M, Mossialos E (eds) Social Policy Developments in Greece: A halfway house reform. Aldershot: Ashgate. 2005.
  40. Costa-Font J, Mossialos E. 'Ambivalent' Individual Preferences towards Biotechnology in the European Union: Products or Processes? Journal of Risk Research 2005;8(4):341-54.
  41. Oliver A, Mossialos E. Health System Reform in Europe: looking back to see forward? Journal of Health Policy Politics and Law 2005:30(1-2):7-28.
  42. Mossialos E, Allin S M. Interest groups and health system reform in Greece. West European Politics 2005; 28(2):421-444.
  43. King D, Mossialos E. The Determinants of Private Medical Insurance Prevalence in England. Health Services Research 2005; 40(1):195-212.
  44. Davaki K, Mossialos E. Plus ça change: health sector reforms in Greece. Journal of Health Policy, Politics and Law 2005:30(1-2):143-168.
  45. Mossialos E, Walley T, Rudisill C. Provider incentives and prescribing in Europe. Expert Review of Pharmacoeconomics & Outcomes Research 2005; 5(1):81-93.
  46. Mossialos E, Allin S, Karras K, Davaki K. An investigation of Caesarean sections in three Greek hospitals. Eur J Public Health 2005 15:288-295.
  47. Mossialos E, Mrazek M, Walley T. (eds) Regulating pharmaceuticals in Europe: striving for efficiency, equity and quality. Buckingham: Open University Press, 2004.
  48. Mossialos E, Thomson S. Voluntary health insurance in the European Union. Copenhagen: World Health Organisation, 2004.
  49. Oliver A, Mossialos E. Equity of access to health care: outlining the foundations for action. J of Epidemiol and Community Health 2004;58(8): 655-658.
  50. Papanicolaou S, Sykes D, Mossialos E, The EMEA and the Evaluation of Health-Related Quality of Life Data in Drug Regulatory Processes. International Journal for Technology Assessment in Health Care 2004;20(3): 311-324.
  51. Bhatia M, Mossialos E. Health Systems in Developing Countries. In Hall A. and Midgley J. (eds) Social Policy for Development. London: Sage, 2004.
  52. Oliver A, Mossialos E, Robinson R. Priority setting and health technology assessment. International Journal of Technology Assessment in Health Care 2004;20(1):1-10.
  53. Mossialos E, Palm W. The European Court of Justice and the Free Movement of Patients in the European Union. International Social Security Review 2003;56(2):3-29.
  54. Mrazek M, Mossialos E. Stimulating pharmaceutical research and development for neglected diseases. Health Policy 2003;64(1):75-88.
  55. Mossialos E, Thomson S, Access to health care in the European Union. In Gulliford M and Morgan M (eds) Access to health care. London: Routledge, 2003.
  56. Mossialos E, McKee M. The influence of EU Law on the social character of health care systems. Brussels: P.I.E. Peter Lang, 2002.
  57. Mossialos E, Dixon A, Figueras J and Kutzin J (eds) Funding health care: Options for Europe. Buckingham: Open University Press, 2002 (Winner of the 2002 European Health Management Association's Baxter Award. Commended: BMA 2002 Book Competition).
  58. Mossialos E, Thomson S. Voluntary Health Insurance in the EU: a critical assessment. International Journal of Health Services, 2002;32(1):19-88.