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Abstract Background Transplantable organs are scarce everywhere. Therefore, countries have developed policies to support the efficient use of potential donors. Nevertheless, the shortage of organs remains. Were these policies in vain? The aim of this study is to assess the impact of donor policies on donor procurement in 10 Western European countries from 1995 to 2005. Method To assess the impact of the donor policies we studied the conversion of potential donors into effectuated donors. 80% of the donors died from CVAs or a (traffic) accident. We considered these mortality rates to be a good proxy for potential donors. Here we call the conversion of potential donors into actual donors 'the donor efficiency rate by proxy'. Results The mortality rates for CVA and (traffic) accidents have decreased in the countries under study. At the same time, in most countries the donor efficiency rates have steadily increased. The variance in donor efficiency rates between countries has also increased from 1995 to 2005. Four countries introduced a new consent system or changed their existing system, without (visible) long-term effects. Conclusion The overall increase in donor efficiency means that the efforts to improve donor policies have paid off. However, substantial differences between countries were found. The success of donor policies in terms of the number of absolute donors is blurred by the success of policies on traffic safety and CVA treatment. It remains unclear which specific policy measures are responsible for the increase in donor efficiency rates. This increase is not related to having a presumed consent system. Furthermore, an analysis of countries that introduced a new consent system or changed their system showed no effect on donor efficiency.

This paper uses data from a European health promotion evaluation study (MAREPS) to empirically test some fundamental assumptions of health promotion theory. Analysis shows that both the competence of individual actors and the opportunities provided for by health-promoting policies are significant predictors of participation in health promotion action. It also demonstrates effects of health promotion values on such action. Moreover, people's perception of their own political efficacy, e.g. their influence on community decisions that effect their health, turns out to be a significant predictor of self-rated health. In conclusion, the paper encourages further research to investigate the effectiveness of health-promoting policy strategies within a multilevel health promotion framework. As the present results indicate, effective health-promoting policies may create opportunities that enable individuals and communities to increase control over the determinants of health, and thereby improve their health.

The results of an exploratory five-nation survey of 2,239 adults interviewed on the telephone indicate general satisfaction with the health care system and less satisfaction with common welfare. In particular German respondents reported minor problems in their experiences with doctors with regard to communication and timing. Concerning health policy, French and Spanish respondents favoured more interventionist medicine, while Germans in particular preferred medicine as care. The public responsibility for care and the shifting of responsibility for future financial needs to employers and the public reveal a tendency that has been called corrupt. Overall, when evaluations and attitudes concerning health care and related policies were controlled for demographic factors, they were not particularly determined by social stratification, which indicates that the health system functions well in providing comprehensive care and securing the identity and integration of society. However, value orientations as a reflection of culture and the respective nationalities are strong determinants of health care systems. National identity confirms at the same time the validity of the comparative approach and the use of multivariate analyses.