Legitimating health care reforms – tracing processes and mapping actors in four countries
PERG Seminar with Imre Szabo, PhD Central European University
Paper co-authored with Amandine Crespy.
Abstract / In this paper, we follow the trajectory of recent healthcare reforms in four European countries: France, Hungary, Ireland and the UK (focusing on England). All of the analyzed reforms went beyond simple cost cutting and tried to achieve a systemic restructuring of health care. However, governments succeeded to push through their original plans to different degrees in the four cases, the French and Hungarian cases being more successful than the Irish and English ones. We explain the difference in outcomes by the varying ability of governments to rely on input and throughput legitimacy during the policymaking process. We proxy input legitimacy with the salience of the reform in electoral competition and with the ideological coherence of governments’ initial reform plans. Then we discuss throughput legitimacy by mapping actors that had access to and influence on the policymaking process in its different stages. We rely on the concept of legitimacy as formulated by Viven Schmidt, but we modify it to be able to account for the fact that governments use throughput legitimacy and expert knowledge in an instrumental way.
Discussant / Alex Moise