Health Policy in Federal States

Abstract

Federalism can be seen as a means to inhibit or slow down centralising political and administrative forces or as a structural measure to peacefully accommodate minority communities. Either way, political and administrative autonomy on member states level renders coordination and coherence of national public policies more difficult. May this institutional setting and its consequences be welcomed in cultural affairs, such as language or religion, it leaves some question marks in reference to social policies, which stress bonds of solidarity and deal with problems of equity. Health policy is a very good example to study these dynamics, because it reacts very sensitively to tensions in federal equilibriums. On the one hand, social differences inherent in federal countries affect the dimensions of equity, organisation and financial viability of the health system. On the other hand, we can expect that problems of health policies affect the nature of federal arrangements, by clearly assigning specific competences either to the central or the sub-national level of government, which increases the demand for coordinated action. Taking this as a starting point, our panel poses the following questions: - How does the distribution of power in federal states between the national level and member states enable or hinder a national policy in health care or public health? - What problems of coordination and coherence are to be faced in a federal state in reference to health policies and how are they overcome? - How do different political ideas about health care, such as solidarity or choice, and public health problems, such as epidemics, influence the institutional governance setting in a federal state?

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