Towards Neo-Bismarckian Health Care States?: Comparing Health Insurance Reforms in Bismarckian Welfare Systems

Germany, France and the Netherlands all have specific ‘Bismarckian’ health insurance systems,which encounter different and specific problems (and solutions) from those of national healthsystems. Following a relatively similar trajectory, the three systems have gone through importantchanges: they now combine universalization through the state and marketization based on regulatedcompetition; they associate more state control (directly or through agencies) and more competitionand market mechanisms. Competition between insurers has gained importance in Germanyand 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 arestill mainly financed by social contribution, managed by health insurance funds, they deliver publicand 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 institutionssince the aim of the reforms is more to change the logic of institutions than to change theinstitutions themselves. Hence, structural changes occur without revolution in the system

How the European Commission's policies are Made : Problematization, Instrumentation and Legitimation

How does the European Commission make its own policies? Research on EU policy-making has generated many indirect, informed answers to this question. However, a focus upon the Commission's internal practices remains under-theorized and under-specified. Drawing upon constructivist, institutionalist and sociological policy analysis, this article instead mobilizes a generic approach to policy-making as 'political work' entailing three overlapping processes: problematization, instrumentation and legitimation. This conceptual framework is then applied to a comparison of Commission policy-making as regards the wine and pharmaceuticals industries. The principal finding is that there are three scope conditions for Commission policy-making which seeks deep institutional change: problematization must be precise rather than vague; instrumentation needs to be programmatic rather than dispersed; and commissioners and senior Commission officials must commit to sustained strategies of legitimation. Overall, this theory-driven approach to policy-making provides a means of shedding new light upon both the Commission and its role within European integration

Who embodies the evaluative state? Programmatic actors in the chilean and colombian policies of quality assurance in higher education

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