Governance Convergence by the Long-Term Constitution of Policy Core Executives: Autonomisation and Centralisation of Health Insurance Policy in Germany and France

Health policy has been dominated by interest groups for decades in western democracies, especially in the health insurance systems embedded in corporatist institutions. In France and Germany major health policy reforms failed similarly in the 1980’s because of the op-position of strong interests groups. Since the early 1990s both countries developed similar strategies to overcome the health policy deadlock based on different kind of institutional changes in the governance struc-tures: the control and the centralization of negotiations between corporatist actors; the transformation of corporatist institutions into more centralized, professionalized and state oriented institutions; the creation of agencies providing tools for the evaluation and control of health providers; the shaping of new centralized financial rules. These institutional changes strengthened the autonomy and the governing capacity of central governments in both countries. This convergence at the governance level, in Germany and France, can be traced back to similar processes of policy, political and social learning (Sabatier 1993; May 1992; Hall 1993) that enabled policy specialists in both countries to build new policy core executives that can be described as “programmatic actors” (Genieys and Smyrl 2008, Hassenteufel et al. 2010). At the same time, transnational epistemic communities (Haas 1992) have gener-ated knowledge that contributed to the development of policy tools for these program-matic actors. For example concepts like diagnostic related groups, evidence-based medi-cine, and integrated care result from transnational networks. The constitution of policy core executives in Germany and France contributes to the un-derstanding of the autonomization of central government organizations in several ways: by the capacity to take major policy decisions against strong interest groups (especially doctors and pharmaceutical industry), by the distant steering of corporatist actors and by a greater control of the implementation of health policy decision at the local level.