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In France, Germany, and Spain, state-strengthening reform of national health policies in the past two decades have been enacted at a time when economic globalization and neo-liberal ideology were combining to encourage the retreat of the state from other areas of economic management and social policy. This article suggests two elements of explanation for that seeming contradiction. The first of these is an increasing reliance on regulatory instruments that allow increased state influence in a context of budgetary rigor. In addition, we find in all three cases that the competition among programmatic for legitimate authority over policy decisions worked to enhance the autonomy of sectoral decision-makers.

Reforming European Health Care States: Programmatic Actors and Policy Change