The changing process and politics of health policy in Korea

Korea recently introduced three major health care reforms: in financing (1999), pharmaceuticals (2000), and provider payment (2001). In these three reforms, new government policies merged more than 350 health insurance societies into a single payer, separated drug prescribing by physicians from dispensing by pharmacists, and attempted to introduce a new prospective payment system. This essay compares the three reforms in Korea and draws important lessons about the country's changing process and politics of health care policy. The change of government, the president's keen interest in health policy, and democratization in the public policy process toward a more pluralist context opened a policy window for reform. Civic groups played an active role in the policy process by shaping the proposals for reform-a major change from the previous policy process that was dominated by government bureaucrats. The three reforms also showed important differences in the role of interest groups. Strong support by the rural population and labor unions contributed to the financing reform. In the pharmaceutical reform, which was a big threat to physician income, the president and civic groups succeeded in quickly setting the reform agenda; the medical profession was unable to block the adoption of the reform but their strikes influenced the content of the reform during implementation. Physician strikes also helped block the implementation of the payment reform. Future reform efforts in Korea will need to consider the political management of vested interest groups and the design of strategies for both scope and sequencing of policy reforms.     

Reform and the politics of hybridization in mature health care states

This article examines the cases of three health care states -- two of which (Britain and the Netherlands) have undergone major policy reform and one of which (Canada) has experienced only marginal adjustments. The British and Dutch reforms have variously altered the balance of power, the mix of instruments of control, and the organizing principles. As a result, mature systems representing the ideal-typical health care state categories of national health systems and social insurance (Britain and the Netherlands, respectively) were transformed into distinctive national hybrids. These processes have involved a politics of redesign that differs from the politics of earlier phases of establishment and retrenchment. In particular, the redesign phase is marked by the activity of institutional entrepreneurs who exploit specific opportunities afforded by public programs to combine public and private resources in innovative organizational arrangements. Canada stands as a counterpoint: no window of opportunity for major change occurred, and the bilateral monopoly created by its prototypical single-payer model provided few footholds for entrepreneurial activity. The increased significance of institutional entrepreneurs gives greater urgency to one of the central projects of health policy: the design of accountability frameworks to allow for an assessment of performance against objectives.     

Health care financing reforms in Germany: the case for rethinking the evolutionary approach to reforms

Health care reform has been a perpetual issue in German politics since reunification. Reform initially focused on restructuring the health care system of the former East Germany. It has subsequently focused on questioning whether the financing of the German social health insurance (SHI) system is sustainable, in light of economic malaise that characterized the 1990s and heightened global competition. In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.     

Why institutions are not the only thing that matters: twenty-five years of health care reform in New Zealand

The literature on the causes of health care reform is dominated by institutionalist accounts, and political institutions are among the most prominent factors cited to explain why change takes place. However, institutionalist accounts have difficulty explaining both the timing and the content of reforms. By applying a range of explanatory approaches to a case study of health reform in New Zealand since the 1970s, this article explores some of the theories of reform beyond institutionalism, particularly those that take into account problem pressure, policy ideas, and the more agency-centered factor of partisan ideology. The aim is not to dismiss institutionalism but to try to fill some of the gaps that cannot be addressed with institutionalist theories alone. The detailed analysis shows that various factors played a role in conjunction, namely, problem pressure, policy ideas, and the ideology of parties in government. Partisan ideology, in particular, has perhaps been prematurely ignored by health care scholars.     

An end to a consensus on health care in the Federal Republic of Germany?

Over the past fifteen years the national government in the Federal Republic of Germany has animated the political debate about rising health care expenditures. However, it has only provided health policy leadership by shifting the burden of financing health and medical care to others. This paper presents three cases that illustrate the political and institutional constraints inherent in the German policy process that limit the proposal and implementation of appropriate policy solutions to rising health care costs. Cost controls have been inhibited because of the near-universal entitlement of national health insurance, the access all social groups have to advanced medical care, and policies targeted at providers rather than users of health services. The paper also underscores the past and future importance of regional policy coalitions in shaping national health policy.     

Report from Germany: current conditions and controversies in the health care system

This paper presents a structured survey of the West German health care and health insurance system, and analyzes major developments of current German health policy. In order to make the analysis more accessible to a largely American audience, brief historical remarks, comparisons with U.S. experience, and considerable data and tabular information are provided. The German statutory health insurance scheme is known as a very comprehensive and generous one. However, under the pressure from rapidly expanding health care expenditures and a severe economic recession, the German governments under Helmut Schmidt and his successor Helmut Kohl imposed a number of cost-containment measures, namely a change in the mode of remuneration for physician services, certain regulations of the drug market, and increased cost-sharing. Cost-sharing is especially favored by the new conservative-liberal government. The article concludes with a summary of striking similarities between the American and German health care schemes, and an outlook on proposals for reform which are currently under investigation by the German government.     

Health care reform in Germany: patchwork change within established governance structures

Under the pressure of health care reform in the 1990s, interactions among the state, sickness funds, and providers in Germany are said to have entered a new era. We examine this new era by assessing both long-term developments connected to German statutory health insurance (SHI) and related short-term developments of the 1990s. Highly institutionalized rules and practices provide little opportunity for abandoning the historical path of two primary factors: the self-governance of SHI and a strong tradition of a semisovereign state. Some opportunities exist for introducing new ideas, rearranging priorities, softening rules, and adding new complex rules and procedures in a fairly fragmented policy-making system, perhaps even because of fragmentation. Yet reforms that depart from the status quo are severely limited by strong legal and administrative traditions and established rules of the game. These restrictions tend to reinforce state intervention, prevent the emergence of consistent and coherent visions of future health policy, and stifle policy innovation and implementation. In sum, reform measures tend to remain well within the priorities established within state and corporatist governance structures.     

Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system

We investigate the impact of the transition towards managed competition in the Dutch health care system on health insurers' contracting behaviour. Specifically, we examine whether insurers have been able to take up their role as prudent buyers of care and examine consumers' attitudes towards insurers' new role. Health insurers' contracting behaviour is investigated by an extensive analysis of available information on purchasing practices by health insurers and by interviews with directors of health care purchasing of the four major health insurers, accounting for 90% of the market. Consumer attitudes towards insurers' new role are investigated by surveys among a representative sample of enrollees over the period 2005-2009. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use 'soft' positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumer attitudes towards channelling vary considerably by type of provider but generally became more negative in the first two years after the reform. Insurers' reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care. The credible-commitment problem seems to be particularly relevant to the Netherlands, since Dutch enrollees are not used to restrictions on provider choice. Since consumers are quite sensitive to differences in provider quality, more reliable information about provider quality is required to reduce the credible-commitment problem.     

The hooligan and his world image in soccer vandalism. An introduction to this current phenomenon of socially deviant behavior

"Hooliganism" is a phenomenon born in the motherland of football: England. But nowadays we all are the non-volunteer spectators of this subculture form of violence and vandalism across the European continent, e.g. in Belgium, the Netherlands, the Federal Republic of Germany and so on. This article is an introduction into the West German Hooligan Scene to learn more about the social, sociological, psychological, criminal backgrounds, characters and causes for a better understanding to solve this multifunctional problem: by police, society and policy.     

Analyzing approaches to internet jurisdiction based on a model of harbors and the high seas

The inherent cross-border nature of the internet has challenged the legal system for over two decades. In this paper we introduce a model in which the internet is approached as if it were the high seas, the harbor of origin, the harbor of destination, or a combination of these. This model is used to rephrase existing case law related to internet jurisdiction from an international law perspective, the US and the EU (in particular Germany and the Netherlands). The model helps to illuminate the positions taken by the parties and the judge, and to indicate possible alternative interpretations. In some cases a high seas approach would have made sense (Yahoo!), or more recently the Vacation Rental by Owner case about trademarks where registration in one country was deemed to have an effect everywhere a person had the trademark on his or her computer screen. In H&M v G-star the Dutch Supreme Court even established jurisdiction based on an infringing product that was not available in the city of the court but was to become available on the internet some time in the future. We do not take a position in this paper on what perspective, based on our model, is best, but make clear how to identify the possible arguments.     

Court of Justice plucks the spider from the web

In recent years the Dutch courts have been willing to grantinterim cross-border injunctions in patent infringement caseswhere the ‘headquarters’ of a group of companiesis located in The Netherlands. A recent decision of the Courtof Justice has put an end to this practice.     

The Contribution of the “Dutch School” in Public Finance to the Theory of Personal Income Taxation (1870–1920)

Hansen's dissertation (1996) is an impressive, highly valuable, and thorough study on the problems of income taxation in Germany. These problems were also extensively discussed in Dutch economic literature around 1900. Several authors took part in the discussion, and some were also involved as politicians. They are referred to as the Dutch School in public finance. The discussions in the Netherlands were of a distinctive character as far as the tax rate (progression) is concerned. With regard to the tax base (the concept of income) there is in the case of the reform of the income tax in 1915, via in particular Treub, close affinity to that thinking in Germany, that is so eminently analyzed by Hansen.     

战后德国养老金制度变迁对我国的启示

事实上,中德两国养老保障制度都正在经历从现收现付向半基金积累模式的转变,也面临人口老龄化等相似状况。尽管德国养老金制度的改革过程缓慢,但所积累的经验使其在改革中充分关注了各利益群体的声音,使得每一代人都能够在较为稳定的政策中享受到养老金待遇,这一点对于我国目前正在变革中的养老保险制度而言尤为值得借鉴。     

Hidden convergence: toward a historical comparison of U.S. and U.K. health policy

The social science literature on the comparative history of the welfare state offers conflicting accounts of the relationship between the United States and the United Kingdom. At first blush, the comparative history of health care policy in the United States and the United Kingdom seems to affirm the dominant view that the U.S. and U.K. welfare states have diverged substantially during the twentieth century. A comparison of U.S. and U.K. health policy, however, suggests that there are more parallels and points of tangency between the two systems than are readily apparent. The comparative history of health policy over the past century reveals common political and policy challenges and frequent interchanges of policy ideas, and helps uncover the political dynamics behind the development of health policy in the two countries, which can, in turn, help illuminate the contemporary politics of reform in both countries.     

Effective Detention: The Development of a Policy

The Dutch Prison Service developed a new policy on indoor employment programmes. The development of this policy, the definition of these programmes and the chosen methodology of Individual Employment Counselling is described. Also some examples of good practice are given. We learned a great deal from good practice, from external advisors, from co-operation with partners like employers, probation services, local authorities and from comparable programmes in other European countries. The development of these programmes was supported by changes in the prison service, economic growth in the Netherlands, a new employment policy initiated by the Dutch government, and by sub-financing of the European Social Fund. Future challenges are: better matching of prisoners (their motivations, their capacities and handicaps) with the programmes, further development of co-operation with partners and the implementation of a good monitoring system.     

地方政府创新中政策企业家知识创造的一个分析模型——以K市公益基金招投标改革为例

政策企业家在推动政府创新中,有无知识创造活动?若有,过程是怎样的?这是政府创新研究中的基本问题之一。论文以知识生产理论为视角,以K市公益基金招投标改革为例,对这一问题进行了研究。主要发现是:政策企业家将其新想法转化为创新方案的认知活动中,运用了其专门知识,创新方案设计活动是新想法、组织外部知识与内部知识的结合;知识创造本质是命题性知识与能力之知间相互作用而转换;知识创造方式包括原理化、操作化、合法化、边界化等;生产过程最后产出了因果知识、工具知识、流程知识、目标知识、预测知识、协调知识等。基于创造方式,论文将政策企业家的知识创造模型命名为ROLD。这一研究的意义在于:尝试从知识创造视角去揭示政府创新微观活动的“黑箱”。     

Judicial Activism in the Name of the Nation: Reneging on the Integration of Immigrants in Greece

Why do courts sometimes decide to liberalize migrants’ rights, while at others restricting such rights, even contrary to the policies of elected governments? This article addresses this question in the context of Greece. It explores the causes and consequences of judicial decision making in a major decision of the Council of State that suspended the most important government reform of 2010, promoting the integration of third‐country nationals. Drawing on judicial politics scholarship, it argues that the ideological and political preferences of key judges were an important influence on the first Council of State decision considered here. However, in the final decision, intra‐court dynamics and the judges’ consideration of external political constraints influenced the court's reasoning, leading to a more moderate outcome, with important consequences for the relaunching of policy reform.     

The war on street ‘terror’. Why tackle anti-social behaviour?

This article examines the rationales of Dutch politicians for tackling the perceived pressing problem of ‘anti-social behaviour’ (ASB) and the question did they copy the British approach? The first part will describe in short the concept of policy transfer and the recent British fight against ASB. The focus will be on the introduction of the Anti-social Behaviour Order. The second part is an empirical study into the Dutch retreat from ‘condoning’ ASB, consisting of interviews with Dutch politicians focusing on their ideas for tackling ASB. Those are compared with the British’s rationales. This kind of comparative elite ethnography is not common in criminology, but this article aims at providing evidence of its benefits. By answering the research question an insight into the origins of policy in the sphere of criminal justice can be obtained.