Wettbewerbskorporatismus und soziale Politik. Zur Transformation wohlfahrtsstaatlicher Politikfelder am Beispiel der Gesundheitspolitik
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Philipps-Universität Marburg
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Abstract
This study deals with health care policy in
Europe. In Europe, national states set the tone for social
policy in general and health policy in particular. Questions of
heath care and institutional reform are, as a rule, treated as
national affairs. For some time, however, the field of health
care policy has begun to show clear signs of a dynamic process
of Europeanization. The present study analyzes the various ways
in which this process is unfolding. Up to now the influence of
European integration on the German health care system has been
driven primarily by the close interlinkage between European law
regulating market structures and German social welfare law. The
newly inaugurated orientation towards a more competitive
market-based economy (The Lisbon Strategy) combined with the
regulatory requirements of the European Economic and Monetary
Union are providing a new impetus toward a Europeanization of
health policy. In addition, the so-called open method of
coordination, which provides a new mode of regulation within
the multi-level European system, is being increasing applied to
the area of health policy. The first part of the study
describes the rise of new political arenas on the European
level in which the European Court, the European Commission and
the European Council are beginning to take more decisive action
with regard to health policy. At the same time, new forms of
interdependence between national health policy and European
decision-making are taking shape. This development is
characterized by opposing trends: On the one hand, existing
national policy options are being restricted within the
framework of European regulations; on the other hand, key
players and major political parties at the national level are
using European decisions in order to assert their own interests
or to meet particular strategic ends. While applying the open
method of coordination to national health care systems is
generating a strategic upgrading of health policy more
generally, results also show that health policy is being
increasingly used as a tool to promote economic competition. It
can be assumed that the integration of European health policy
within the financial framework of the European Union, including
the new European goals regarding economic competition, will
increase pressure on member states to curb cost expansion and
to strengthen competition in health care provision. At the same
time, experience from other countries may contribute to
eliminating deficiencies within the German health care system,
particularly in regard to the inefficiency of current
structures. The second part of the study deals with the role of
a committee of the German health system responsible for the
distribution of health benefits. Mostly unnoticed by the
public, the Bundesauschuss der Ärzte und Krankenkassen (Federal
Committee of Physicians and Sickness Funds), as it was called
until 31 December 2003, turned into an influential institution
particularly during the second half of the 1990s making
far-reaching decisions concerning health benefit entitlements
from the compulsory sickness insurance (Gesetzliche
Krankenversicherung - GKV). Step by step the state transferred
appropriate powers to the committee ? most of all in
order to exonerate itself from the risks of legitimation
arising from restrictions on the grant of benefits from the
GKV. Insofar the Federal Committee functions as an agent for a
paradigmatic change which has often been described as marking
the transition from an expansive health policy to a health
policy based on competition and aiming at stable contribution
rates. The study reconstructs this transfer of tasks from the
state to the Federal Committee which can be as well
characterized as a change towards ?competitive
corporatism?. Moreover, it undertakes an analysis of how
those involved in the granting of benefits are - by specific
state intervention - induced to develop a preference for a
restrictive interpretation of the benefits catalogue, thereby
supporting the aims of state regulations, while the state
reserves for itself the right to final decisions through a
system of specific reservations and substitutions. As a
conclusion, the paper deals with contradictions arising from
the transfer of regulative competences from the state to the
Commission and presents a short outlook on the growing
importance of EU-jurisdiction with regard to the organization
of national health systems.
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Dates
Created: 2003Issued: 2004-03-18Updated: 2011-08-10
Faculty
Fachbereich Gesellschaftswissenschaften und Philosophie
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
Health care policy, Welfare StateCorporatismEuropean Integration
DFG-subjects
Europäische IntegrationGesundheitspolitik , WohlfahrtsstaatKorporatismus
DDC-Numbers
300
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Urban, Hans-Jürgen (128509716): Wettbewerbskorporatismus und soziale Politik. Zur Transformation wohlfahrtsstaatlicher Politikfelder am Beispiel der Gesundheitspolitik. : Philipps-Universität Marburg 2004-03-18. DOI: https://doi.org/10.17192/z2004.0089.
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This item has been published with the following license: In Copyright