Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T09:14:57.488Z Has data issue: false hasContentIssue false
  • English
  • Français

Institutions, Veto Points, and Policy Results: A Comparative Analysis of Health Care *

Published online by Cambridge University Press:  28 November 2008

Ellen M. Immergut
Ellen M. Immergut
Affiliation:
Political Science Massachusetts Institute of Technology
Get access Rights & Permissions [Opens in a new window]

Abstract

The medical profession is reputed to control decision-making in medical care to such an extent that one can speak of professional dominance. Yet West European health policies have radically changed the working conditions and incomes of doctors in many countries. Why have some governments been able to ‘socialize’ medicine? This article seeks to refute the view that the medical profession exercises a universal veto power. In contrast to scholars who explain medical influence in terms of singular characteristics of the medical profession or through the historical process of professionalization, this essay focuses on the properties of distinct political systems that make them vulnerable to medical influence. It argues that we have veto points within political systems and not veto groups within societies. By comparing the lobbying efforts of medical associations in Switzerland, France, and Sweden, the article analyses the role of political institutions in accounting for different patterns of medical association influence on health policy.

Type
Articles
Information
Journal of Public Policy , Volume 10 , Issue 4 , October 1990 , pp. 391 - 416
Copyright
Copyright © Cambridge University Press 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abbott, Andrew (1988). The System of the Professions. An Essay on the Division of Expert Labor. Chicago: The University of Chicago Press.CrossRefGoogle Scholar
Altenstetter, Christa (1976). ‘The Impact of Organizational Arrangements’, pp. 3–33 in Altenstatter, C. (ed.), Changing National-Subnational Relations in Health. Washington, DC: Fogerty International Center and Department of Health, Education and Welfare.Google Scholar
Archives (1960). Archives Nationales. Direction de la Sécurité Sociale. Ministère des Affaires Sociales et de la Santé. ‘Travaux préparatoire à la réforme de la Sécurité de 1960’, SAN 7514–7519. ‘Scurité Sociale-Ré,formes’ SS 2711–2. ‘Honoraires’, SS 7082–4. SAN 7557.Google Scholar
Ashford, D. (1986). ‘The British and French Social Security Systems: Welfare State by Intent and by Default’, pp. 96–122 in Ashford, Douglas E. and Kelley, E. W., (eds.), Nationalizing Social Security. Greenwich, CT: JAI Press.Google Scholar
Aubert, J. F. (1978). ‘Switzerland,’ pp. 39–66 in Butler, D.Ranney, A. (eds.), ‘Refcrcndums’. A Comparative Study of Practice and Theory. Washington, DC: American Enterprise Institute for Public Policy Research.Google Scholar
Berlant, J. (1975). Profession and Monopoly: A Study of Medicine in the United States andGreat Britain. Berkeley, CA: University of California Press.Google Scholar
Birnbaum, Pierre (1977). Les Sommets de l'Etat. Paris: Editions du Seuil.Google Scholar
Botschaft, (1961). ‘Botschaft des Bundesrates an die Bundesversammlung zum Entwurf eines Bundesgesetzes betrefTend die Änderung des Ersten Titels des Bundesgesetzes uber die Krankenund Unfallsversicherung (vom 5. Juni 1961)’, Bundesblatt, 113, no. 25, I: 1417–1528.Google Scholar
Blanpain, Jan with Luc, Delesie and Herman, Nys (1978). National Health Insurance and Health Resources. Cambridge, MA: Harvard University Press.CrossRefGoogle Scholar
Braun, Rudolf (1985). ‘Zur Professionalisierung des Ärztestandes in der Schweiz’ pp. 332–357 in Jürgen, Kocka (ed), Bildungsbiirgertum im 19. Jahrhundert. Stuttgart: Klett-Cotta.Google Scholar
Carder, Mack and Klingeberg, Bendix (1980). ‘Towards a Salaried Medical Profession: How “Swedish” was the Seven Crowns Reform?’ pp. 143–172 in Heidenheimer, and Elvander, (eds), The Shaping of the Swedish Health System. London: Croom Helm.Google Scholar
Cibrie, Paul (President of the CSMF) (1954). Syndicalism Médical Paris: Confédération des Syndicats Medicaux Francois (CSMF).Google ScholarPubMed
Duverger, M. (1976). Institutions politiques et droit constitutional. Vol. 2. Le système politique français. Paris: Presses Universitaires de France.Google Scholar
Doublet, Jacques (1971). ‘La Sécurité Sociale et son évolution [octobre 1951-juin 1961]’, Revue Francaise des Affaires Sociales, 25, no. 2 (04–06): 26–60.Google Scholar
Eckstein, Harry (1960). Pressure Group Politics: The Case of the British Medical Association. London: Allen & Unwin.Google Scholar
Ehrmann, H. (1976). Politics in France, Third Ed.Boston: Little Brown & Co.Google Scholar
Elvander, Nils (1972). Svensk Skaltepolitik 1945–1970. En Studie i partiers och organisationers funktioner.Stockholm: Rabén och Sjögren.Google Scholar
Freddi, Giorgio and Björkman, James Warner (1989). Controlling Medical Professionals: The Comparative Politics of Health Governance. Newbury Park, CA: Sage Publications, Inc.Google Scholar
Friedson, E. (1970). Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York: Dodd, Mead & Companny.Google Scholar
Galant, Henry C. (1955). Histoire Politique de la Sécurité Sociale Française. 1945–1952. Caliiers de la Fondation Nationale des Sciences Politiques No. 76. Paris: Librairie Armand Colin.Google Scholar
Garpenby, P. (1989). The State and the Medical Profession. A Cross-National Comparison of the Health Policy Arena in the United Kingdom and Sweden 1945–1985. Linköping: Linköping Studies in Arts and Sciences.Google Scholar
Gebert, Albert J. (1976). ‘Cooperative Federalism or Muddling through: the Swiss Case’, pp. 95–139 in Altensteter, (ed.), Changing National-Subnational Relations in Health. Washington, DC: Fogerty International Center and Department of Health, Education and Welfare.Google Scholar
GFS Schweizerische Gesellschaft für Praktische Sozialforschung (1988). ‘Analyse der eidgenössichen Abstimmung vom 6. Dezember 1987’, GFS Publications, 12, nr. 34 (March). Zürich: GFS.Google Scholar
Glascr, William A. (1970). Paying the Doctor: Systems of Remuneration and their effects. Baltimore: Johns Hopkins Press.Google Scholar
Gruner, Erich (1969). Regierung und Opposition im schweizerischen Bundesstaat. Series Statt und Politik, no. 7. Bern: Verlag Paul Haupt.Google Scholar
Gruner, Erich (1973).Politische Führungsgruppen im Bundestaat. Bern: Francke Verlag.Google Scholar
Gruner, Erich(1977). Die Parteien in der Schweiz, 2nd ed. Bern: Francke Verlag.Google Scholar
Hammond, T. H. and Miller, G. J. (1987). ‘The Core of the Constitution,’ American Political Science Review, Vol. 81, No. 4, (12), pp. 1155–1173.CrossRefGoogle Scholar
Hatzfeld, Henri (1963). Le Grand Toumanl de la Médecine Libérate. Paris: Les Editions Ouvrières.Google Scholar
Hatzfeld, Henri(1971). Du Paupérisme a la Sécurité Sociale. Essai sur les Origines de la Sécurité Sociale en France, 1850–1940. Paris: Librairie Armand Colin.Google Scholar
Heclo, H. and Madsen, H. (1987). Policy and Politics in Sweden: Principled Pragmatism. Philadelphia: Temple University Press.Google Scholar
Heidenheimer, Arnold J. (1980). ‘Conflict and Compromise Between Professional and Bureaucratic Health Interests, 1947–1972’, pp. 119–142 in Heidenheimer, & Elvander, (eds), The Shaping of the Swedish Health System. London: Croom Helm.Google Scholar
Hesslén, G. (1927). Det Svenska Kommittéväsendet intill år 1905. Dess uppkomst, stållning och betydelse. Doctoral Dissertation, filosofiska fakultetet i Uppsala humanistiska sektion, Uppsala.Google Scholar
Hogarth, James (1963). The Payment of the Physician. Some European Comparisons. NY: Macmillan Co.(Pergamon Press).Google Scholar
Hughes, C. (1962). The Parliament of Switzerland. London: Cassell.Google Scholar
Imbert, Jean (1958). ‘La réforme hospitalière’, Droit Social, 21, no. 9–10 (09–10): 496–505.Google Scholar
Jamous, Haroun(1969). Sociologie de la Décision: la réforme des éludes médicates et des structures hospitalières. Paris: Editions du Centre Nationale de la Recherche Scientifique.CrossRefGoogle Scholar
Kelman, S. (1981).Regulating America, Regulating Sweden: A Comparative Study of Occupational Safety and Health Policy. Cambridge, MA: MIT Press.Google Scholar
Kerr, H. (1981). Parlement et Société en Suisse. St. Saphorin: Editions Georgi.Google Scholar
Klein, Rudolf (1979). ‘Ideology, Class and the National Health Service,’ J. of Health Politics, Policy and Law, 4 (Fall): 464–490.CrossRefGoogle ScholarPubMed
Kocher, Gerhard (1972). Verbandseinfluss auf die Gesetzgebung. Aertzeverbindung, Krankenkassenverbände und die Teilrevision 1964 des Kranken- und Unfallsversicherungsgesetzes, 2nd ed. Bern: Francke Verlag.Google Scholar
KSK (1958–1960). Konkordat der schweizerischen Krankenkassen, Tätigkeitsbericht (Konkordat of Sickness Funds, annual report).Google Scholar
(LT) Läkartidningen. (Journal of the Swedish Medical Association).Google Scholar
Laroque, Pierre (1971), ‘La Sécurité Sociale de 1944 a 1951’, Revue Franfaise des Affaires Sociales, 25, no. 2 (04–06): 11–25.Google Scholar
Light, Donald and Sol, Levine (1988). ‘The Changing Character of the Medical Profession: A Theoretical Overview’, The Milbank Quarterly, 66, Suppl. 2, 10–32.CrossRefGoogle ScholarPubMed
Lipsky, Michael (1968). ‘Protest as a Political Resource’, APSR 62, 1144–1158.CrossRefGoogle Scholar
MacRae, D. (1967). Parliament, Parties and Society in France, 1946–1958. NY: St. Martin's Press.Google Scholar
Mane, Roland (1962). ‘Où va le syndicalisme médical?’ Droit Social, 25, no. 9–10 (09–10):516–529Google Scholar
Marmor, Theodore R. and Thomas, David (1972). ‘Doctors, Politics and Pay Disputes: “Pressure Group Politics” Revisited,’ British Journal of Political Science 2: 421–442CrossRefGoogle Scholar
Maurer, A. (1982). ‘Switzerland’, pp. 384–453 in Köhler, Peter A, Zacher, Hans F. (eds), The Evolution of Social Insurance. 1881–1981. Studies of Germany, France, Great Britain, Austria and Switzerland. London & NY: Frances Pinter and St. Martin's Press.Google Scholar
Maxwell, R. J. (1981). Health and Wealth. An International Study of Health Care Spending. Lexington, MA: Lexington Books, D. C. Heath and Company for Sandoz Institute for Health and Socio-Economic Studies.Google Scholar
Meynaud, Jean (1958). Les Groupes de Pression en France. Cahiers de la Fondation Nationale des Sciences Politicjues No. 96. Paris: Librairie Armand Colin.Google Scholar
Ncidhart, Leonhard (1970). Plebiszit undpluralitäre Demokratie. Eine Analyse der Funktion der Schweizerischen Gesetzreferendums. Bern: Francke Verlag.Google Scholar
Nyman, O. (1947).Svensk Parlamentarism 1932–1936. Från Minoritetsparlmentarism till majoritetskoalition. No. 27, Skrifler Utgivna av Slalsvelenskapliga Foreningen i Uppsala genom Axel Brusewitz. Uppsala: Almqvist & WicksellGoogle Scholar
Ög Anita, Jarold (1962). ‘Diskussion kring Medicinalstyrelsens betänkande, “Den öppna läkarvården i riket’.” Unpublished paper from the pro-seminar in Political Science, Uppsala University.Google Scholar
Ramsey, M. (1984). ‘The Politics of Professional Monopoly in Nineteenth-Century Medicine: The French Model and Its Rivals’, pp. 225–305 in Geison, G. L. (ed.), Professions and the French State. Philadelphia: University of Pennsylvania Press.Google Scholar
Revue de le Sécurité sociale (Journal of the FNOSS, the organization of social security funds).Google Scholar
Riksdagens Protokoll, FK. (Parliamentary debates of the First Chamber).Google Scholar
Sarfatti Larson, M. (1977). The Rise of Professionalism. A Sociological Analysis. Berkeley: University of California Press.CrossRefGoogle Scholar
Savatier, Jean (1962). ‘Une Profession libérale face au mouvement contemporain de socialisation’, Droit Sociale, 25, no. 9–10 (09–10): 477–479.Google Scholar
Scharpf, F. W. (1989). ‘Decision Rules, Decision Styles, and Policy Choices’, Journal of Theoretical Politics 1: 149–176.CrossRefGoogle Scholar
Schattschneider, E. E. (1960). The Semi-Sovereign People. NY: Holt, Reinhart.Google Scholar
Shepsle, K.A. (1986). ‘Institutional Equilibrium and Equilibrium Institutions’, pp. 51–81 in Weisberg, (ed.), Political Science: the Science of Politics. NY: Agathon.Google Scholar
Sköld, Lars and Halvarson, Arne (1966). ‘Riksdagens Sociala Sammansättning under Hundra År,’ pp. 375–493 in Samhälle och Riksdag. Del I. STH: Almqvist & Wicksell.Google Scholar
Starr, Paul (1982). The Social Transformation of American Medicine. NY: Basic Books.Google Scholar
Stenbull, SRAmtliches Stenographisches Bulletin der schweizerischen Bundesversammlung.Ständerat, (Parliamentary debates of States' Council.)Google Scholar
Steflen, Monika ( 1983). Régulation Politique et Stratégies Prqfessionnelles: Médicine Libérale et Emergence des Centres de Santé. Thèse d'Etat. Institute d'Etudes Politiques. Université des Sciences Sociales de Grenoble II, Grenoble.Google Scholar
Steflen, Monika (1987). ‘The Medical Profession and the State in France,’ Journal of Public Policy, 7, 2, 189–208.CrossRefGoogle Scholar
Stephan, Jean-Claude (1978). Economie et Pouvoir Médical. Paris: Economica.Google Scholar
Stone, D. (1980). The Limits of Professional Power. Chicago: Chicago University Press.Google Scholar
SvD. Svenska Dagbladet. Swedish Conservative newspaper.Google Scholar
Tocqueville, Alexis de (1958[1856]). The Ancien Régime and the French Revolution. NY: Doubleday, Anchor Books.Google Scholar
Wilsford, David (1986). ‘French Doctors and the State’, paper presented at the APSA Meetings,08.Google Scholar