Health Governance Convergence in France and Germany

• In Event: Health Policy in Comparative Perspective

Abstract

French and German health policies, which due to their Bismarckian health care systems face similar problems and power issues but are embedded in very different political environments (Bandelow et al. 2017). On the one hand, health systems produce increasing pressure for political intervention to secure financeability, health care quality, equal treatment of patients and high-quality jobs in the health care sector despite demographic, economic and technological evolutions. On the other hand, political actors face influential interest groups that defend positions related to the status quo of the system. These challenges affect Bismarckian health system in particular as these systems rely on shaky contributions and have to deal with systems of self-governance that produce special veto points for strong interest groups (Schubert, de Villota, and Kuhlmann 2016).
This paper compares the institutional level of governance structures in health care systems and asks how far there is a convergence process of governance structures in the French and German health care systems since the 1990s, despite different political environments and against the backdrop of similar challenges and problems.
Our main argument is that similar perception of problems and challenges in health insurance policy by groups of key policy actors linked to the state have produced similar endogenous governance changes in both countries. To underpin this postulation, we will draw from interview data gathered within research projects on comparative health policy (Hassenteufel et al. 2010; Hornung and Bandelow 2018). Document analyses accompany the interview data that includes ministers, health policy advisers, senior civil servants, experts, members of Parliament, and interests group leaders.

References

Bandelow, Nils C., Colette S. Vogeler, Johanna Hornung, Johanna Kuhlmann, and Sebastian Heidrich. 2017. "Learning as a Necessary but Not Sufficient Condition for Major Health Policy Change: A Qualitative Comparative Analysis Combining ACF and MSF." Journal of Comparative Policy Analysis: Research and Practice:1-16. doi: 10.1080/13876988.2017.1393920.
Hassenteufel, Patrick, Marc Smyrl, William Genieys, and Francisco Javier Moreno-Fuentes. 2010. "Programmatic Actors and the Transformation of European Health Care States." Journal of Health Politics, Policy and Law 35 (4):517–38. doi: 10.1215/03616878-2010-015.
Hornung, Johanna, and Nils C. Bandelow. 2018. "The Programmatic Elite in German Health Policy: Collective Action and Sectoral History." Public Policy and Administration. doi: 10.1177/0952076718798887.
Schubert, Klaus, Paloma de Villota, and Johanna Kuhlmann. 2016. "Challenges to European Welfare Systems." In. Switzerland: Springer International Publishing.

Authors

• Nils C. Bandelow, TU Braunschweig

• Patrick Hassenteufel, Université de Versailles Saint-Quentin enYvelines

• Johanna Hornung, TU Braunschweig