About the Project

DFG-ANR Project „Ensuring medical care in disadvantaged regions. An international comparison of policy strategies in Germany, France, England and Sweden“


Research questions

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 compares 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 explaining 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?

Research design and methods

The project is to be classified as basic research. It stands out by its interdisciplinary and internationally comparative character. With its specific research questions, which are equally important for the three disciplines involved, Health Policy-Analysis, Public Health and Sociology (Health Systems Research), the project focusses on a still rather neglected aspect within the larger context of social scientific research on the supply of medical care. So, both data on the health political strategies of different national states against the undersupply of outpatient medical care as well as a systematic cross-country comparison of such strategies are actually missing. What is more, we currently do not know much about the mutually influential impact of the perception of the problem of undersupply of medical care typical for a certain health system and of the institutional arrangements, power resources and regulatory structures on the national formulation of policies against the (regional and local) undersupply of outpatient medical care.

The project contributes to the filling of this academic void. Based on qualitative research methods (document analysis, secondary analysis, expert interviews) we, first, gather systematic empirical knowledge on the supply of outpatient medical care in the four countries explored. Second, with a double perspective of Health Policy-Analysis and Health Systems Research in mind, we aim at gaining theoretical knowledge in terms of the explanation of short- to medium term policy change and long-term health systems change. In this context, in a first step we analyse the causal relationship between national health systems, the problem perception concerning the supply of outpatient medical care by the relevant actors within the respective system and the selection of health policy strategies related to the supply problem. In a second step we examine whether the formulation of health policy goals and the selection of health policy instruments for the (regional) regulation of the supply of outpatient medical care contribute to the emergence of new institutional structures in terms of the regulation of health care supply (hybridization) or whether these activities rather reflect the traditional regulatory framework of the respective national health system (path dependence).

Conceptual background and steps of analysis

In order to answer the research questions, the project is based on an analytical concept which integrates fundamental theoretical assumptions of actor-centred institutionalism, the veto-player theory and discursive constructivism. Following these assumptions, institutions typical for a certain national health system impact on the health political process, its output and its outcomes in two ways. First, they structure the health political process and assign specific resources and veto power to the relevant actors in the flied (e.g. national health administrations, statutory health insurance funds, confederations of medical doctors etc.). Second, they pre-structure the openness of the health political system for the influence of both exogenous and endogenous factors, like e.g. certain developments in the socio-economic environment or the national news coverage on the supply problem. As for the allocation of ‘issue attention-resources’ to the relevant health political actors national health systems constitute a filter regarding the perception of health policy problems, the formulation of health political strategies and the conception of health policy solutions for certain problems. Based on these considerations we formulated a number of hypotheses which are to be tested in three analytical steps in the course of the project:

  1. The analysis of the respective national health political discourse > Here, the patterns of the perception of the supply problem dominating the national political discourse on the problem, the explanations of the problem and the preferences of possible solutions by health political actors are examined.
  2. The analysis of recent health political strategies dealing with the supply problem > Here actual policies in terms of the supply problem and their policy-analytical explanations are scrutinized for the period of examination from 2000 to the present.
  3. The analysis of recent regional supply policies > Here the consideration of national policy goals and the implementation of the according policy strategies as well as the application of policy instruments in the context of the regional regulation of outpatient medical supply will be analysed.
DFG-ANR Project RegMedProv