The governance of hospital markets — Comparing two Bismarckian countries

Abstract

The privatization of hospitals has become a reform trend throughout Europe since the beginning of the 1990s. So far, the scholarly debate has focused primarily on changes in the welfare mix, concluding from the rising share of private for‐profit providers, a growing convergence of hospital governance throughout Europe. This paper sheds light on a neglected aspect of the reform trend, namely the differences in the regulation of the newly evolved hospital markets. The governance of hospital markets is discussed through the lens of the “tools of government” approach, taking Germany and France as examples. Empirically, the paper provides an overview of the major changes in the instruments applied in the field of hospital policy in both countries since the 1990s. Analytically, it contributes to the literature on policy instruments by refining the tools of government approach. We propose a typology that allows us not only to classify instruments of hospital policy but also to relate the changes in instrument choice to the changes in statehood.