Patrick Hassenteufel

The medical profession and health insurance policies: A Franco‐German comparison

Abstract In Germany doctors arc highly organized within the welfare state, whereas in France they have traditionally fought against this. As they are more institutionalized, German doctors have a key position in health insurance policy networks, which arc referred to as ‘asymmetric corporatism’. In France the state ‐ facing a less institutionalized and more fragmented medical profession ‐ is the central actor in the network, characterized as ‘statist’. Cost‐containment policies are adjusted to those networks: self‐administrative regulation in Germany, administrative regulation in France. The limitations of these policies have led to changes. In Germany the exclusive reform of 1992 cannot be explained solely by political factors: the transformation of the organized representation of doctors has to be taken into account. In France changes are limited because of the non co‐operative strategy of those involved in their implementation: the doctors, first and foremost, but also the sickness funds.

Policy Diffusion and Translation: The Case of Health Agencies

After a discussion of the concepts of policy diffusion, policy transfer and policy convergence, we put forward the analytical potential of the translation framework combining three dimensions: the discursive dimension, the actor’s dimension and the institutional dimension. With the case of the shaping of evidence-based bureaucracies using quality evaluation and cost benefit analysis in three western European healthcare systems (uk, France and Germany), we give an example of how this framework can be operationalized and explain why it enables to understand divergent convergence processes.

Germany: Mixing Rescaling, Privatization and Managerialism

Since the early 1990s, European public health care systems have experienced dynamic transformation processes. Health care systems have come under the pressure of strong financial constraints, indicating the end of the ‘golden age’ of welfare state policy. Thus, the most important issue at hand is cost control. Various tools have been employed in order to contain rising costs. The broad range of different reform measures can be categorized into three major reform types, namely privatization, managerialization and rescaling, for example the reshaping of the distribution of decision-making authority.

The academic world of French policy studies: training, teaching and researching

The gap between the policy analysis developed by policy actors and the existing academic knowledge on public policies has been identified in previous chapters as being central in France. This chapter aims at exploring and providing some explanation of this division. As with the rest of this book it relies upon the distinction between, on the one hand,policy analysis, defined as ‘applied social and scientific research – but also involving more implicit forms of practical knowledge – pursued by government officials and non-governmental organisations which usually focus on designing, implementing and evaluating existing policies, programmes and other courses of...

Muddling Through the Crisis: The French Welfare State Under Financial Stress

If the crisis reinforced the pressure to reform the French Welfare State under the scrutiny of the European Commission, these reforms were difficult to decide (and to implement) because of their political costs and more generally the low legitimacy of political actors (especially the current socialist government and the President Francois Hollande). The legitimacy issue is crucial because since the institutional reform of 1996 (plan Juppe) the French state is more directly accountable for welfare reforms in health care and unemployment where traditionally non-state actors (social partners, doctors …) played a key role. In the context of the crisis, the French authorities tried to negotiate reforms with non-state actors in these two sectors in order to avoid the political blame. The French Welfare State is also challenged by demographic evolutions. Although France has a rather high level of fertility, ageing affects the population as in other European countries. However, the impact of demographic evolutions seems weaker than the financial impact of the crisis on the French Welfare State which has not, however, changed its reform path which began in the mid 1990s.