The Winds of Winter: COVID-19 and Punctuations Without Policy Change in German Health Care Policy

Abstract

ABSTRACT In the second half of the 19th legislative period, COVID-19 brought the issue of health policy firmly into the public limelight. Given that it amplified already existing challenges, this crisis can be conceptualised as a case of positive feedback in the understanding of punctuated equilibrium theory (PET). One would have expected this crisis to provide a push for reforms in the areas of digitalisation, hospital and care policy, as these represent both the policy path taken by the Minister of Health at the beginning of the legislative period and a response to the problems caused by the pandemic. However, none of these areas were addressed in any significant way by health policymakers after the COVID-19 outbreak, leaving us to wonder why a shift in attention and positive feedback did not lead to major reforms. To answer this question, we link PET to the multiple streams framework (MSF) to explain why positive feedback has not led to major reforms in German health policy. We show that the policy stream – with a lack of measures ready for adoption – and the politics stream, with power struggles within parties and between levels of government, explain why major reforms have not been adopted.