The Politics of Health Care Provision in Disadvantaged Regions: Germany, France, England, and Sweden Compared

Ensuring adequate health care is a core task of public policy in advanced European welfare states. Regardless of increasing numbers of health professionals (notably physicians), different European countries are facing growing difficulties to allow for adequate health care in disadvantaged (i.e. rural, structurally weak) regions. Thus, insufficient availability of health care in those areas is a subject of major concern. Our paper focuses on policy strategies tackling this problem in four European countries (Germany, France, England, and Sweden). These countries represent two main types of health systems (national health service, health insurance system) accounting for rather centralised (England, France) and rather de-centralised (Germany, Sweden) welfare states. The countries practice different modes of multi-level governance and of coordination with non-state actors in health policy. Moreover, they differ in terms of the role traditionally assigned to physicians, nurses, and other professions in health care (focus on specialist care in Germany and France vs. primary care in England and Sweden).

Our paper is developed in the context of an international research project comparing national policy strategies for the supply of outpatient medical care in disadvantaged regions. The project just took up and is co-funded by the German Science Foundation (Deutsche Forschungsgemeinschaft, DFG) and the French National Research Agency (Agence nationale de la recherche, ANR). We aim at analyzing how problems are being perceived and attempts for problem-solving regulation are being designed in these countries. Policy instruments chosen resp. envisaged may range from financial incentives for health professionals to settle in disadvantaged areas to a reorganisation of supply structures and a redefinition of health workers’ roles. Thus, our project seeks to explore the change of the regulatory and institutional structures in different health care systems.