Premium
Towards Neo‐Bismarckian Health Care States? Comparing Health Insurance Reforms in Bismarckian Welfare Systems
Author(s) -
Hassenteufel Patrick,
Palier Bruno
Publication year - 2007
Publication title -
social policy and administration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.972
H-Index - 63
eISSN - 1467-9515
pISSN - 0144-5596
DOI - 10.1111/j.1467-9515.2007.00573.x
Subject(s) - marketization , competition (biology) , welfare state , health care , health policy , health care reform , state (computer science) , economics , public health , economic growth , public economics , economic policy , business , political science , medicine , ecology , algorithm , politics , law , computer science , china , biology , nursing
Germany, France and the Netherlands all have specific ‘Bismarckian’ health insurance systems, which encounter different and specific problems (and solutions) from those of national health systems. Following a relatively similar trajectory, the three systems have gone through important changes: they now combine universalization through the state and marketization based on regulated competition; they associate more state control (directly or through agencies) and more competition and market mechanisms. Competition between insurers has gained importance in Germany and the Netherlands and the state is reinforcing its controlling capacities in France and Germany. Up to now, continental health insurance systems have remained, however, Bismarckian (they are still mainly financed by social contribution, managed by health insurance funds, they deliver public and private health care, and freedom is still higher than in national health systems), but a new ‘regulatory health care state’ is emerging. Those changes are embedded in the existing institutions since the aim of the reforms is more to change the logic of institutions than to change the institutions themselves. Hence, structural changes occur without revolution in the system.