CEPEL

ProAcTA

ProgrammaticActioninTimesofAusterity–ProAcTA

Elite Competition and Health Sector Governance in France, Germany, the UK, and the USA

(2008–2018)

French Principal Investigator:

William GENIEYS
, University of Montpellier (UM) (CEPEL – CNRS)

Team:

Saïd DARVICHE (UM / CEPEL)
Marc SMYRL (UM / CEPEL)
Farid BOUSSAMA (UM / CEPEL)
Patrick HASSENTEUFEL (University of Versailles-St Quentin / Labo.Printemps)

Partners:

Lawrence BROWN (Columbia University)
Adam OLIVER (London School of Economics)
Anne-Laure BEAUSSIER (University of Versailles-St Quentin / Labo.Printemps)

Budget:€333,000

German Principal Investigator:

Nils BANDELOW
, TU Braunschweig

Team:

Colette VOGELER (Braunschweig University of Technology)
Johanna HORNUNG (Braunschweig University of Technology)

Partners:

Florian ECKERT (Bayer)
Robin RUESENBERG (Doctor’s Association dagnä)
Klaus SCHUBERT (University of Münster)

Budget:€215,331

  • What are the social and professional characteristics of individuals directly involved in reforming or defending health policy programs? Under what circumstances do they come together to form relevant and influential collective actors?
  • To what extent have arguments centered on the defense of public authority and/or the sustainability of health systems been invoked by public health advocates in response to the challenge of austerity, and how successful have they been in the ongoing battle with proponents of austerity?
  • What new or repurposed policy instruments have been implemented by program actors?
  • Structure and History of Health Payment Systems
  • The scope, timing, and political significance of austerity policies

French Principal Investigator:

William GENIEYS
, University of Montpellier – UM (CEPEL – CNRS)

Team:

Saïd DARVICHE (UM / CEPEL)
Marc SMYRL (UM / CEPEL)
Farid BOUSSAMA (UM / CEPEL)
Patrick HASSENTEUFEL (University of Versailles – St Quentin / Labo.Printemps)

Partners:

Lawrence BROWN (Columbia University)
Adam OLIVER (London School of Economics)
Anne-Laure BEAUSSIER (University of Versailles-St Quentin / Labo.Printemps)

Budget:€333,000

German Principal Investigator:

Nils BANDELOW
, TU Braunschweig

Team:

Colette VOGELER (Braunschweig University of Technology)
Johanna HORNUNG (Braunschweig University of Technology)

Partners:

Florian ECKERT (Bayer)
Robin RUESENBERG (Doctor’s Association dagnä)
Klaus SCHUBERT (University of Münster)

Budget:€215,331

Summary:

ProAcTA refines and implements the Programmatic Actor Framework to test the following hypothesis in the United States, the United Kingdom (England), Germany, and France between 2008 and 2018:

In the health policy sector of Western democracies, budgetary austerity has had the counterintuitive effect of providing specialized sectoral elites who favor maintaining or expanding the public sector’s role (policy custodians) with the means and incentive to reaffirm their own authority and autonomy within the state, in competition with other elites whose agenda exploits the rhetoric of austerity to support program cuts (austerians).

Both custodians and austerians are examples of programmatic actors, whose characteristics were developed in our previous work and are defined in detail in this proposal. In this context, ProAcTA contributes to the testing of a broader hypothesis:

Competition for authority among policy actors provides both an endogenous driver of policy change and a necessary explanation for policy content.

Programmatic actors, custodians, and austerians are ideal types. TheProgrammatic Actor Frameworkhelps to define them. Through systematic biographical data, in-depth targeted interviews, and detailed policy content analysis, we determine to what extent collective actors embodying these roles can be identified. In particular, we ask:

  • What are the social and professional characteristics of individuals directly involved in reforming or defending health policy programs? Under what circumstances do they come together to form relevant and influential collective actors?
  • To what extent have arguments centered on the defense of public authority and/or the sustainability of health systems been invoked by public health advocates in response to the challenge of austerity, and how successful have they been in the ongoing battle with proponents of austerity?
  • What new or repurposed policy instruments have been implemented by program actors?

An important area of research is the extent to which functional equivalents—relating both to the composition of elites and to their strategies—can be identified across national systems that, while all facing significant budgetary pressures, differ in key respects. We identify two clusters of structural variables that are expected to shape and constrain the actions of elites:

  • Structure and History of Health Payment Systems
  • The scope, timing, and political significance of austerity policies

In defining these, we aim to move beyond both the conventional typology of social welfare systems and the dichotomy between liberal and statist programs. This allows us to re-examine the assumptions held by both supporters of social policy retrenchment and its critics by subjecting to empirical testing the premise—too often taken for granted—that the various strategies associated with austerity (budget cuts, privatization, outsourcing…) have necessarily weakened the scope and authority of the state.

French Principal Investigator:

William GENIEYS
, University of Montpellier – UM (CEPEL – CNRS)

Team:

Saïd DARVICHE (UM / CEPEL)
Marc SMYRL (UM / CEPEL)
Farid BOUSSAMA (UM / CEPEL)
Patrick HASSENTEUFEL (University of Versailles-St Quentin / Labo.Printemps)

Partners:

Lawrence BROWN (Columbia University)
Adam OLIVER (London School of Economics)
Anne-Laure BEAUSSIER (University of Versailles-St Quentin / Labo.Printemps)

Budget:€333,000

German Principal Investigator:

Nils BANDELOW
, TU Braunschweig

Team:

Colette VOGELER (Braunschweig University of Technology)
Johanna HORNUNG (Braunschweig University of Technology)

Partners:

Florian ECKERT (Bayer)
Robin RUESENBERG (Doctor’s Association dagnä)
Klaus SCHUBERT (University of Münster)

Budget:€215,331

  • What are the social and professional characteristics of individuals directly involved in reforming or defending health policy programs? Under what circumstances do they come together to form relevant and influential collective actors?
  • To what extent have arguments centered on the defense of public authority and/or the sustainability of health systems been invoked by public health advocates in response to the challenge of austerity, and how successful have they been in the ongoing battle with proponents of austerity?
  • What new or repurposed policy instruments have been implemented by program actors?
  • Structure and History of Health Payment Systems
  • The scope, timing, and political significance of austerity policies