Abstract
This article aims to understand what makes member states complement federal healthcare policy beyond the instruments planned by federal policy. We employ a Multiple Streams approach to study how Swiss member states use their discretion in order to complement federal healthcare regulation with the aim of decreasing outpatient healthcare expenditures at the cantonal level. Based on a written survey in the Swiss cantons, we perform a Fuzzy Set Qualitative Comparative Analysis (fsQCA), which places a keen emphasis on complex patterns. The method identifies what combinations of determinants make it particularly likely that a canton opts for complementary policy activity. Several configurations prove to foster such activity. While this is important, it is also important to pay attention to the constellations that precisely do not foster complementary policy activity. Our analysis of the cantonal choices on governing outpatient healthcare reveals that party politics in the executive and/or the public administration play a major role in this task, whereas neither organized interests within the medical profession nor individual policy entrepreneurs are crucial. Federalist systems offer opportunities for policy innovations the federal level ultimately may benefit from.
Highlights
This article aims to understand what makes member states complement federal policy beyond the instruments planned by the federal policy
Our analysis of the cantonal choices on governing outpatient healthcare reveals that party politics in the executive and/or the public administration play a major role in this task, whereas neither organized interests within the medical profession nor individual policy entrepreneurs are crucial
The results of the survey show that numerous cantons display initiative and use their room for manoeuvre within the existing federal regulation setting in combination with the Health Insurance Law (HIL) to develop innovative solutions
Summary
This article aims to understand what makes member states complement federal policy beyond the instruments planned by the federal policy. The basic implication of this narrative is that member states by default deviate from the central state directive they are supposed to implement. In this contribution, we want to complement this one-sided view of member state implementation by taking the Swiss case to show how member state discretion can have a positive effect on public service delivery by allowing member states to complement federal regulation. As the Organization for Economic Cooperation and Development (OECD) and the World Health Organization (WHO) (2011, p.43) put it: “The ambulatory care sector provides general medical advice, diagnostic services, obstetrics care, perinatal care, care for children, family planning, minor surgery, rehabilitation, dental care and home-based care”. Ambulatory care is largely provided by independent physicians and so-called outpatient departments of hospitals
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