Figurations Leading to Post-Crisis Convergence of Bismarckian Health Systems towards the Beveridge Model: Combining Conditions of the Advocacy Coalition Framework and the Multiple Streams Approach
Qualitative Comparative Analysis
The financial crisis produced pressure on Bismarckian health systems that led to reforms across European welfare states. Some of these reforms pointed to a conversion through elements of the Beveridge model while others did not. We will present a standardized empirical study to explain these differences of the health care reform output using QCA (Ragin 1987; Cronqvist/Berg-Schlosser 2009).
The conditions are adopted from the ACF and the MSA to operationalize figurations leading to the inclusion of Beveridge elements by Bismarckian health systems. By combining these two approaches, we will be able to present a more comprehensive picture of the reform processes, relying on the significance of both policy learning within particular actor coalitions (as particularly important in the ACF) and the role of ambiguity and timing (as particularly important in the MSA).
From the ACF we adopt conditions based on the elements “policy oriented learning”, “external events” (which is also included in the MSA), “internal shocks”, “negotiated agreements”, “lineup of advocacy coalitions”, and “political opportunity structures” (Sabatier/Jenkins-Smith 1993; Sabatier/Weible 2007). The MSA provides conditions connected to the three streams of the MSA, ambiguity and timing, and the existence of specific types of “policy entrepreneurs” (Zahariadis 1995/2008; Kingdon 2011; Herweg et al.2015; Zohlnhöfer 2016).
Empirical cases are health care reforms in traditional Bismarckian systems after 2008 (Austria, Germany, France, Belgium, Slovakia). Data is provided by large projects like the WHO European Observatory on Health Systems and Policies (WHO 2016).
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