Health Politics: Interests and Institutions in Western Europe

Ellen Immergut vividly demonstrates the tremendous impact political institutions can have on policy in this comparative analysis of the politics of national health insurance in Sweden, France, and Switzerland - three countries where the same legislative proposals have been considered but where the policy result vary widely. In each country, politicians proposed programmes of national health insurance and measures to regulate the economic activities of the medical profession. Although these proposals triggered similar political conflicts and reactions in all three countries, the Swiss, French, and Swedish health systems developed in divergent directions as a result of the specific legislative proposals enacted into law in each country: the Swedish system can be considered the most 'socialized' in Western Europe, the Swiss the most 'privatized', and the French a conflict-ridden compromise between the two. Immergut argues that institutional rules and procedures, and not the demands and resources of social groups, set the terms for political conflicts. By providing distinct opportunites and impediments to both politicians and interest groups, political institutions establish distinct 'rules of the game' that explain the ability of various groups to influence policy making. Political institutions thus play a primary role both in structuring political conflicts and in accounting for divergent policy outcomes.