Austerity as Redistributive Impulse: The Policy History of Health Care Cost Containment in Austria and Germany
Sprache des Vortragstitels:
Englisch
Original Tagungtitel:
30th International Conference of Europeanists. Lyon
Sprache des Tagungstitel:
Englisch
Original Kurzfassung:
Over the past three decades, the prevailing theme in Western health reform has been the imperative of cost containment. In conceiving of austerity as a redistributive impulse, this paper adopts a political economy perspective to examine the impact of austerity politics on a decentralized policy sector characterized by substantial autonomy among meso- and micro-actors.
A qualitative comparison of Austria and Germany, two social insurance countries, forms the core of this analysis. Health governance is similar in the two countries in that power-sharing institutions both along corporatist and federal lines play an important role, but they differ the specific design of delegated public authority. And they also differ in their specific approaches to cost containment.
The comparison also uncovers a shared and consistent trend in institutional change, however: Contrary to expectations rooted in notions of blame avoidance tactics employed by governments as they implement unpopular policies, the consequence of austerity's redistributive impulse on the health system is centralization.
This paper explains why this is so. It sheds light on how central governments, facing fiscal constraints, strategically pivot towards gaining control over medical care and the practice of medicine. This happens sometimes at the expense of governance autonomy on the part of meso- and micro-actors, sometimes by coopting self-government institutions into the central government?s agenda. The paper also demonstrates that the centralizing impetus fluctuates with the ebb and flow of fiscal strain on the health system. In essence, it explains the politics of redistribution in the health system, as driven by austerity.
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