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From Maastricht to Brexit by Richard Bellamy and Dario Castiglione

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

Comparative Politics
Political Theory
Public Policy
Social Policy
Welfare State
Qualitative Comparative Analysis
Nils Bandelow
TU Braunschweig
Nils Bandelow
TU Braunschweig
Colette Vogeler
TU Braunschweig
Johanna Kuhlmann
Universität Bremen
Sebastian Heidrich
TU Braunschweig

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).

Cronqvist, Lasse, Berg-Schlosser, Dirk (2009): Multi-Value QCA (mvQCA). In: Rihoux, Benoit and Charles Ragin: Configurational Comparative Methods: Qualitative Comparative Analysis (QCA) and Related Techniques. London: Sage Publications, pp 69–86.
Herweg, Nicole; Huß, Christian; Zohlnhöfer, Reimut (2015) Straightening the Three Streams: Theorizing Extensions of the Multiple Streams Framework. In: European Journal of Political Research 54 (3), pp. 435–449.
Kingdon, John W. (2011) Agendas, Alternatives, and Public Policies. 2. edition. Longman, Boston.
Ragin, Charles C. (1987): The Comparative Method. University of California Press, Berkeley and Los Angeles.
Sabatier, Paul A.; Jenkins-Smith, Hank C. (1993) Policy Change and Learning: An Advocacy Coalition Approach. Westview Press, Boulder.
Sabatier, Paul A.; Weible, Christopher M. (2007) The Advocacy Coalition Framework. Innovations and Clarifications. In: Sabatier, Paul A. (ed.) Theories of the Policy Process. Westview Press, Boulder pp. 189-220.
WHO (2016) European Observatory on Health Systems and Policies.
Zahariadis, Nikolaos (1995) Markets, States, and Public Policy. Privatization in Britain and France. University of Michigan Press, Ann Arbor.
Zahariadis, Nikolaos (2008) Ambiguity and Choice in European Public Policy. In: Journal of European Public Policy 15 (4), pp. 514–530.
Zohlnhöfer, Reimut (2016) Putting Together the Pieces of the Puzzle: Explaining German Labor Market Reforms with a Modified Multiple-Streams Approach. In: Policy Studies Journal 44 (1), pp. 83-107.
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