The (mis)fit of policy programs to political institutions and its influence on programmatic action – How crisis has differently hit French and German health policy

The Programmatic Action Framework (PAF) is a relatively new theoretical perspective that adds complementary lens to the explanation of policy processes and change. Yet, key requirement valid process framework its capacity be proven wrong. Besides empirical cases provide evidence for occurrence programmatic action, it necessary present examples in which action did not occur, explain why this case. Proceeding from observation groups programs existed French German health throughout 1990s, contribution answers question 2020, still France but Germany program survive financial crisis 2008. It argues misfit pre-existing institutional logics changing course hinder success. 计划行动框架（PAF）是一个相对较新的理论视角，它对政策过程和政策变革的解释进行了补充。然而，一个有效的政策过程框架的关键要求是其可证伪性。尽管存在实证案例证明计划行动的出现，但有必要提出计划行动并未出现的那些案例，并解释背后的原因。从“计划群体和政策计划在20世纪90年代存在于法国和德国的卫生政策”这一发现出发，本文回答了相关疑问，即为何计划行动在2020年仍然存在于法国，但不存在于德国，以及为何德国的政策计划在2008年金融危机中失败。本文论证认为，与既有制度逻辑的不匹配以及计划行动过程中不断变化的制度逻辑，阻碍了计划的成功。 El Marco de Acción Programática es una perspectiva teórica relativamente nueva que agrega lente complementaria la explicación los procesos políticos y el cambio políticas. Sin embargo, un requisito clave marco proceso político válido su capacidad para demostrar está equivocado. Además casos empíricos evidencian ocurrencia acción programática, necesario presentar ejemplos en programática no ocurrió explicar por qué así. Partiendo observación grupos programáticos programas políticas existieron política salud francesa alemana durante década 1990, esta contribución responde pregunta todavía presente Francia pero Alemania programa alemán sobrevivió. financiera Argumenta desajuste las lógicas institucionales preexistentes cambiantes curso obstaculizan éxito del programa. explains stability change by focusing on biographical intersections form basis social – jointly promote their transform into policies. Studies have identified existence defense (Faure, 2020; Genieys, 2010) care systems France, Germany, Spain, USA (Hassenteufel et al., 2010). While confirms within similar period time alike (Genieys & Hassenteufel, 2015; Hornung Bandelow, 2020), recent research shows as opposed phase seems ended (Bandelow Hornung, 2020). is, what these divergent pathways previously existent two countries? This becomes even more relevant light 2008/2009, predestined opportunity solutions match arising problems, marked beginning end program. At when could focused challenges survive. Why there at are deeply needed? Answering question, draws program-related hypotheses PAF identifies driving factors continuation or respective case policy. In doing so, investigates characteristics make fail succeed long-term. article coherence program, ability address adapt emerging challenges, narrative fit national mood been moderated design policy-making. increasing role coalition negotiations between political instead administrative actors constrains possibility react short-term strengthens sectoral actors. Furthermore, correspond system begin with. By contrast, institutions stable, followed usual hierarchical governance mechanism. Empirical postulation provided total 31 interviews with who were members groups. begins reviewing against backdrop institutions. To do Section 2 outlines added value embedding existing stability. With an explicit focus approaches, deductively derived literature instrument mixes, problem pressure, approaches. Subsequently, 3 presents methodological procedure, analysis 4 discussion results 5. 6 concludes development PAF. provides relies assumption use push themselves group careers normative desire shape sectors certain substantial direction Hassenteufel Thereby, attachment subjective identification (Hornung 2019) As Advocacy Coalition (ACF), according engage collective shared core beliefs encompass variety elite actors, politicians journalists (Weible 2019), coalesce result biographies consist directly involved decision-making processes. argued defined instance transforming law, likely close state. These large bureaucratic apparatus power positions serve incentives given they ensure exertion authority once occupied significant number resources individual's command. Originating observations public 2001), idea has grown and, after application other examples, systematized both theoretically empirically set standard procedure analyze empirics possess groundwork, can further connected state art play adoption. ever influence discussed already al. (2010), trace elites education account labeling coalition. assess interdependent programs, sensible incorporate insight policies PAF's relate Although informed institutions, although borrows some arguments path dependency, distinct logic. historical institutionalists scholars dependence often concerned hinders (Pierson, 1993), seeking enable Especially policy, explained much inability achieve major changes (Brown, 2010; Steinmo Watts, 1995). Recent developments institutionalist perspectives increasingly how ideas agency produce critical junctures (Hogan, 2019). actor-centered takes evolve manifest (Thelen, 2003), strength sustain A different isomorphism supposes structures force, imitation, creation knowledge foundation around groups, search efficient competitive setting (DiMaggio Powell, 1983). Reviewing change, van der Heijden Kuhlmann (2018) find latter isomorphism, during organization transforms homogenizes due professionalization staff, least observed unclear whether low interest lack evidence. also look recruitment personnel one aspect trajectories, less organizations economy, agencies apparatuses occupying positions. that, assumes come together pursue aim fostering implications. If goal, credited Before drivers success, operationalizable definition. Research range explanations succeed. However, definitions success failure recur questions adopted led improvement outcomes. Marsh McConnell (2010) distinguish three dimensions whereby evaluative assessment met objective termed another concerns consequences government. third dimension, furthermore most describes successful adoption proposed Posing should benefit successful, drawing work (2020), assert equitable increase sense accomplishment processes, rather than situation others. order such just formulates actor-related hypotheses. designates joins successfully promotes joint over decade. novel explaining directional long nameable promoted struggle authority. intentionally focuses non-existence test formulated assesses way settings moderate effect thereby essentially contributing under conditions live long-term original version PAF, Program Coherence Hypothesis states enacted if coherent. Beginning instruments points importance mixes (Howlett Rayner, 2017), predominantly objectives measures align each other, emphasizes congruence (program) design. Put differently, “assessing reasons choice any area requires multivariate since exist structure nature types level overall government crucial affecting decisions actions.” (Howlett, 2009, p. 84). From point view, addition “layers” regulation must observe place incompatibilities (Edmondson 2019, 4). same time, may help implement shield arrangements alteration through (Béland integrated Institutionalization Integrating dimension design, add Congruence postulating congruent arrangement sector system. wording inspired research, remains terminological confusion used synonymously (Lenz Glückler, Rodrigo 2009). means extent fits mode governance. purely coherent solution, goal attained. later uses illustrative Nevertheless, concepts volatile insofar alienate changes. vein, itself alter settings. better designed arrangement, will acquiring envisaged objectives. naïve understanding problems referred able pressing regulative sector. terms Responsiveness Hypothesis, sees program's them own sake factor Other strands designate example reference policy-making times (Savage, 2019; Steinebach Wenzelburger reaction rising expenditures efficiency (Schmid Weinstein Skinner, Given future cannot anticipated correctly thus underlie great uncertainty, considered dependent situations, solve upcoming apparently functional way, does exactly (Hannah, 2018). Only recently, COVID-19 pandemic outlined responses established (Petridou, Sager Mavrot, Weible hypothesis, would assume challenges. only marginal here. External pressure stop nor encounter. might early warning fast recognition deal Such facilitate content related flexibility final predisposition lies communication packaging reforms. view Fit persist responsive dominant mood. Narrative approaches gained evermore prominence (Shanahan 2017). Any framed potential overcome actively exploit empathetic fallacies recipients (Crow Jones, 2018), persuade independent exact actual problem-solving such, important take communicating reform programs. concept inherent MSF, context public's stance issues. Similar NPF, MSF pointed towards leaders promotion proposal, frame making opinion polls, media, activist (Zahariadis, 2015, 468). regard parties up mood, visible strong protest, act out partisan interests (seeking office votes) (Herweg 2015). embeddedness appears influences Institutional need responsiveness depending blame avoidance strategies (Zohlnhöfer 2016). Inspired review, expected here: Depending claiming climate respect proposal formally participate process, party democracy (Karremans Lefkofridi, 2020) corporatist (Godt, 1987), anchor appear (Program Connectivity Hypothesis). Building considerations, Figure 1 model tested crisis, required stable direct single explanatory following shed dynamics Source: Explanatory taken Bandelow (2020) elaborated; illustration model, study turns comparison selection based premises. First, phenomenon none anymore circumstance illustrated detail studies. Secondly, roles competition though Bismarckian contribution-based insurance systems, (sickness funds, physicians' associations) differ incorporated consequence, impact programs' Thirdly, apart differences, all constant equally, orientation governments, general relation ambulatory stationary care. therefore proceeds steps: first step reviews occurred characteristics. looks phases existed, namely 1981 2020 1990 2010, observed, 2011 2020. Against backdrop, tests regarding traces institutionally countries. determine bases review reforms, inductively expert interviews. Methodologically, forces part analytical scheme took not. table visualizes lead heuristically compare very small N four cases. Based flow diagram presented 1, applied detailed studies consists six coded absent. moderating particularly connectivity qualitative analyses Step two, 5, discusses results, resulted so discussing presence absence study, relevance outcome action. For purposes, documents, literature, analyzed aspects coherence, competition. conducted November 2018 January quoted analysis; done anonymously function interviewee guarantee confidentiality statements. perspectives, link characteristics, environment themselves, visualized tested. supposed was developed 1980s answer expenditures. Following decrease costs, tried contain spending introducing parliamentary oversight More concretely, Plan Juppé 1995 mandated parliament annually expenditure target security, annual budget prepared responsible department ministry. measure logic dominates policy-making, normally characterized weak rationalized parliamentarism. centralization system, factual strengthening Directorate Social Security (Direction Sécurité Sociale, DSS) executive branch government, style. continued strengthen merging regional territorial level, Regional Hospital Agencies (Agences Régionales d'Hospitalisation, ARH) restructuring Health Santé, ARS), monopoly representation sickness strengthened ministry's advisory body, Inspection Génerale des Affaires Sociales. last affected Loi Hopitals, Patients, Territoires (HPST) 2009. Thus, non-introduction elements planning contracting mechanisms perfectly line tradition (Bellanger Mossé, 2005). 2010 group. reforms made management tools, tendency re-centralization competences remained (Simonet, tendencies marketization private insurance, unintended (BenoÎt Coron, regulatory remain consistent consistency ensured spending, being oriented prevention digitalization, (Lombrail, circumscribed actors: introduction originally follow self-governance, resistance Care Structure Act 1992 Modernization 2002 faced. 2007 labeled “Act Strengthen Competition SHI”. caused weaken representation. debated actually served diminished corporatism (Allen Riemer Hommel, 2006). Accordingly, benefits self-governance agreements traditionally reach bargaining providers payers hand down got lost “competitive corporatism” (Rhodes, 2001). self-governing moved internal unanimous external prevails associations, rules game negotiated association representatives. intended neo-corporatist bargaining, wage labor costs insured, payments funds services offered providers, changed substantially years (Molina Rhodes, 2002). Besides, show turn evidence-based decision-making. establishment Institute Quality Assurance Efficiency (Insti