Ensuring medical care in disadvantaged regions. An international comparison of policy strategies in Germany, France, England and Sweden.

• Applicants: Professor Dr. Thomas Gerlinger; Dr. Renate Reiter
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine ; Political Science
• Term: from 2015 to 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 264600888

Ensuring adequate outpatient medical care is a core task of public policy in advanced welfare states. Though the physicians density is increasing the number of regions with insufficient availability of medical care continues to grow. In the medium term, these problems are predicted to exacerbate. This research project is going to compare the political strategies of selected West European welfare states (Germany, France, Great Britain, Sweden) tackling this problem from 2000 to the present. Research focusses the following questions: 1. What are the goals pursued, and instruments selected, in order to tackle the problem of existing or threatening insufficient availability of outpatient medical care in the period in question? 2. What are the factors which explain the respective goal formulation and choice of instruments? 3. In how far is the policy formulation accompanied by a change of the respective health care systems, especially with regard to regulation and the structure of service delivery? The first question addresses the policy-related empirical knowledge by exploration. On the basis of data and documents available a typology of problem perception and policy formulation is to be developed. The second question aims at gaining theoretical knowledge on comparative state activity and health care systems research by qualitative empirical analysis und explanation of change. On the basis of hypotheses derived from theory the inter-related effects between the national health care systems and the selection of political strategies will be analyzed. Our particular interest is the question for the role of the stakeholders problem perception, their power resources and the institutional structures of the respective health care system. The third question focuses on the change of health care systems. We analyze whether the goal formulation and the choice of instruments regionally regulating outpatient medical facilities in the individual health care systems create new regulative und institutional structures (hybridization) or whether problem-solving remains within their regulative and institutional framework historically developed (path dependency). Thus, by international comparison the problem of divergence or convergence of health care systems will be analyzed. This qualitative study is methodologically based on the content analysis of documents (expert reports, policy papers, parliamentary debates etc.) concerning reform policies and expert interviews. The analysis of strategies at the national level will be supplemented by regional case studies. Apart from the scientific knowledge gain the findings of this research project promise to provide benefits both in practical and political terms. It is expected to heighten perception for national policy transfer.

• DFG Programme: Research Grants
• International Connection: France
• Co-Investigator: Professor Dr. Patrick Hassenteufel