Is Service Quality a Driver of the Regulatory Welfare State? Policies for Health Services in Germany and France

• DOI: 10.1177/0002716220962407
• Date: 01 September 2020
• Author: Renate Reiter
• Published date: 01 September 2020

174 ANNALS, AAPSS, 691, September 2020

DOI: 10.1177/0002716220962407

Is Service

Quality a Driver

of the

Regulatory

Welfare State?

Policies for

Health Services

in Germany and

France

By

RENATE REITER

962407ANN THE ANNALS OF THE AMERICAN ACADEMYIs Service Quality a Driver?

research-article2020

The article analyzes the design and development of

health services in Germany and France—two countries

with similar welfare states but with striking differences

in their national regulatory styles. Using these com-

parative cases, I show how the interplay of long-term

institutional factors and short-term political factors

shaped the establishment and development of these

regulatory welfare states’ (RWS) social services.

Specifically, I argue that the discovery of service quality

in the 1990s had the potential to accelerate RWS devel-

opment. In Germany, characterized by a corporatist

state tradition and a cooperative regulatory style, the

political debate on quality (either as a parameter of

competition or as a concept for the professional con-

solidation of service production) had a greater influ-

ence on the design of the national quality regulation

system (goals, instruments, processes, institutions) than

in France, which is characterized by a state-centered

Napoleonic tradition and a directive regulatory style.

Keywords: regulatory welfare state; regulatory style;

health care; quality policy; Germany; France

In the light of growing pressure from globali-

zation and demographic and social change,

the “mature” welfare state has been the object

of “profound transformation” (Hemerijck 2013,

27ff.) since the late 1980s. A whole body of lit-

erature has developed around this theme, argu-

ing that this transformation went hand-in-hand

with a move toward the containment of public

spending in different sectors; the privatization

and/or re-commodification of certain functions,

infrastructure, and costs (van Kersbergen and

Vis 2014, 9); and the “dismantling” of public

Renate Reiter is a senior fellow in the Department of

Political Sciences at the FernUniversität in Hagen,

Germany. She specializes in comparative policy analysis,

particularly from a Franco-German perspective;

public regulation in the welfare state; and public

administration. She focuses on the political fields of

social and health policy.

Correspondence: renate.reiter@fernuni-hagen.de