Wettbewerbskorporatismus und soziale Politik. Zur Transformation wohlfahrtsstaatlicher Politikfelder am Beispiel der Gesundheitspolitik

This study deals with health care policy in Europe. In Europe, national states set the tone for social policy in general and health policy in particular. Questions of heath care and institutional reform are, as a rule, treated as national affairs. For some time, however, the field of health care policy has begun to show clear signs of a dynamic process of Europeanization. The present study analyzes the various ways in which this process is unfolding. Up to now the influence of European integration on the German health care system has been driven primarily by the close interlinkage between European law regulating market structures and German social welfare law. The newly inaugurated orientation towards a more competitive market-based economy (The Lisbon Strategy) combined with the regulatory requirements of the European Economic and Monetary Union are providing a new impetus toward a Europeanization of health policy. In addition, the so-called open method of coordination, which provides a new mode of regulation within the multi-level European system, is being increasing applied to the area of health policy. The first part of the study describes the rise of new political arenas on the European level in which the European Court, the European Commission and the European Council are beginning to take more decisive action with regard to health policy. At the same time, new forms of interdependence between national health policy and European decision-making are taking shape. This development is characterized by opposing trends: On the one hand, existing national policy options are being restricted within the framework of European regulations; on the other hand, key players and major political parties at the national level are using European decisions in order to assert their own interests or to meet particular strategic ends. While applying the open method of coordination to national health care systems is generating a strategic upgrading of health policy more generally, results also show that health policy is being increasingly used as a tool to promote economic competition. It can be assumed that the integration of European health policy within the financial framework of the European Union, including the new European goals regarding economic competition, will increase pressure on member states to curb cost expansion and to strengthen competition in health care provision. At the same time, experience from other countries may contribute to eliminating deficiencies within the German health care system, particularly in regard to the inefficiency of current structures. The second part of the study deals with the role of a committee of the German health system responsible for the distribution of health benefits. Mostly unnoticed by the public, the Bundesauschuss der Ärzte und Krankenkassen (Federal Committee of Physicians and Sickness Funds), as it was called until 31 December 2003, turned into an influential institution particularly during the second half of the 1990s making far-reaching decisions concerning health benefit entitlements from the compulsory sickness insurance (Gesetzliche Krankenversicherung - GKV). Step by step the state transferred appropriate powers to the committee ? most of all in order to exonerate itself from the risks of legitimation arising from restrictions on the grant of benefits from the GKV. Insofar the Federal Committee functions as an agent for a paradigmatic change which has often been described as marking the transition from an expansive health policy to a health policy based on competition and aiming at stable contribution rates. The study reconstructs this transfer of tasks from the state to the Federal Committee which can be as well characterized as a change towards ?competitive corporatism?. Moreover, it undertakes an analysis of how those involved in the granting of benefits are - by specific state intervention - induced to develop a preference for a restrictive interpretation of the benefits catalogue, thereby supporting the aims of state regulations, while the state reserves for itself the right to final decisions through a system of specific reservations and substitutions. As a conclusion, the paper deals with contradictions arising from the transfer of regulative competences from the state to the Commission and presents a short outlook on the growing importance of EU-jurisdiction with regard to the organization of national health systems.