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Reforming European Health Care States: Programmatic Actors and Policy Change

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Abstract:

This paper presents the conclusions of a primary research project on the reform of national health systems in France, Germany, Spain and the U.K. In all of these countries, the decades from the late 1980s to the present have witnessed significant change. Although this has included the spread of internal competition and growing autonomy for certain non-state and para-state actors, it does not follow that the mechanism at work is a “neo-liberal convergence.” Rather, what we observe is that the translation into diverse national settings of quasi-market mechanisms is accompanied in every case by a reassertion of regulatory authority and, in France and Germany, by the strengthening of statist, as opposed to corporatist, management of national insurance systems. The use of quasi-market tools, thus, brings state-strengthening reform. The proximate and necessary cause of this dual transformation is to be found in each of our cases in the work of small closely-integrated groups of policy professionals whom we label “programmatic actors.” While their identity differs across cases, the functional role and motivation of these actors is strikingly similar. Motivated by a desire to wield authority through the promotion of programmatic ideas, rather than by material or careerist interests, these elite groups act both as importers and translators of ideas and as architects of policy. The resulting elite-driven model of policy change integrates ideational and institutionalist elements to explain programmatically coherent change despite institutional resistance and partisan instability.

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health (157), polici (95), state (80), actor (78), reform (73), care (65), programmat (58), system (52), polit (44), nation (39), social (34), case (33), govern (31), public (31), group (30), chang (30), autonomi (29), sector (29), new (29), franc (28), insur (27),

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public policy, policy change, health, europe
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Name: APSA 2008 Annual Meeting
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http://www.apsanet.org


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URL: http://citation.allacademic.com/meta/p279462_index.html
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MLA Citation:

Hassenteufel, Patrick., Smyrl, Marc., Genieys, William. and Moreno-Fuentes, Javier. "Reforming European Health Care States: Programmatic Actors and Policy Change" Paper presented at the annual meeting of the APSA 2008 Annual Meeting, Hynes Convention Center, Boston, Massachusetts, Aug 28, 2008 <Not Available>. 2014-12-01 <http://citation.allacademic.com/meta/p279462_index.html>

APA Citation:

Hassenteufel, P. , Smyrl, M. E., Genieys, W. and Moreno-Fuentes, J. , 2008-08-28 "Reforming European Health Care States: Programmatic Actors and Policy Change" Paper presented at the annual meeting of the APSA 2008 Annual Meeting, Hynes Convention Center, Boston, Massachusetts Online <PDF>. 2014-12-01 from http://citation.allacademic.com/meta/p279462_index.html

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: This paper presents the conclusions of a primary research project on the reform of national health systems in France, Germany, Spain and the U.K. In all of these countries, the decades from the late 1980s to the present have witnessed significant change. Although this has included the spread of internal competition and growing autonomy for certain non-state and para-state actors, it does not follow that the mechanism at work is a “neo-liberal convergence.” Rather, what we observe is that the translation into diverse national settings of quasi-market mechanisms is accompanied in every case by a reassertion of regulatory authority and, in France and Germany, by the strengthening of statist, as opposed to corporatist, management of national insurance systems. The use of quasi-market tools, thus, brings state-strengthening reform. The proximate and necessary cause of this dual transformation is to be found in each of our cases in the work of small closely-integrated groups of policy professionals whom we label “programmatic actors.” While their identity differs across cases, the functional role and motivation of these actors is strikingly similar. Motivated by a desire to wield authority through the promotion of programmatic ideas, rather than by material or careerist interests, these elite groups act both as importers and translators of ideas and as architects of policy. The resulting elite-driven model of policy change integrates ideational and institutionalist elements to explain programmatically coherent change despite institutional resistance and partisan instability.


Similar Titles:
Elite Discourse, Public Opinion, and Significant Social Policy Change during the Clinton Administration: The Cases of Welfare and Health Care

National Health Care Reform is Around the Corner Again: Lessons from the Clinton Plan, State Children's Health Insurance Program and Massachusetts Reform


 
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