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Institutions, Veto Points, and Policy Results: A Comparative Analysis of Health Care

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  • Immergut, Ellen M.

Abstract

The medical profession is reputed to control decision-making in medical care to such an extent that one can speak of professional dominance. Yet West European health policies have radically changed the working conditions and incomes of doctors in many countries. Why have some governments been able to ‘socialize’ medicine? This article seeks to refute the view that the medical profession exercises a universal veto power. In contrast to scholars who explain medical influence in terms of singular characteristics of the medical profession or through the historical process of professionalization, this essay focuses on the properties of distinct political systems that make them vulnerable to medical influence. It argues that we have veto points within political systems and not veto groups within societies. By comparing the lobbying efforts of medical associations in Switzerland, France, and Sweden, the article analyses the role of political institutions in accounting for different patterns of medical association influence on health policy.

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  • Immergut, Ellen M., 1990. "Institutions, Veto Points, and Policy Results: A Comparative Analysis of Health Care ," Journal of Public Policy, Cambridge University Press, vol. 10(4), pages 391-416, October.
    • Handle: RePEc:cup:jnlpup:v:10:y:1990:i:04:p:391-416_00
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    Cited by:

    1. Fritz Sager, 2009. "Governance and Coercion," Political Studies, Political Studies Association, vol. 57(3), pages 537-558, October.
    2. Ralf Och & Birgit Pfau-Effinger, 2023. "Marketisation policies in the neoliberal era: How culture and governance structures affect the introduction of market principles in local care policies," Environment and Planning C, , vol. 41(3), pages 448-465, May.
    3. Jesse Bump & Susan Sparkes & Mehtap Tatar & Yusuf Celik & Meltem Aran & Claudia Rokx, 2014. "Turkey On The Way Of Universal Health Coverage Through The Health Transformation Program (2003-13)," Health, Nutrition and Population (HNP) Discussion Paper Series 93172, The World Bank.
    4. Andrea Leiter & Engelbert Theurl, 2012. "The convergence of health care financing structures: empirical evidence from OECD-countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 7-18, February.
    5. Resnick, Danielle & Babu, Suresh & Haggblade, Steven & Hendriks, Sheryl L. & Mather, David, 2015. "Conceptualizing Drivers Of Policy Change In Agriculture, Nutrition, And Food Security: The Kaleidoscope Model," Feed the Future Innovation Lab for Food Security Policy Research Papers 258732, Michigan State University, Department of Agricultural, Food, and Resource Economics, Feed the Future Innovation Lab for Food Security (FSP).
    6. Tenbensel, Tim & Eagle, Samantha & Ashton, Toni, 2012. "Comparing health policy agendas across eleven high income countries: Islands of difference in a sea of similarity," Health Policy, Elsevier, vol. 106(1), pages 29-36.
    7. Georg Wenzelburger & Pascal D. König & Frieder Wolf, 2019. "Policy Theories in Hard Times? Assessing the Explanatory Power of Policy Theories in the Context of Crisis," Public Organization Review, Springer, vol. 19(1), pages 97-118, March.
    8. Blanchet, Nathan J. & Fox, Ashley M., 2013. "Prospective political analysis for policy design: Enhancing the political viability of single-payer health reform in Vermont," Health Policy, Elsevier, vol. 111(1), pages 78-85.
    9. Meijdam, A.C. & Ponds, E.H.M., 2013. "On the Optimal Degree Of Funding Of Public Sector Pension Plans," Other publications TiSEM 1c5b7af1-e1ee-4d01-a341-f, Tilburg University, School of Economics and Management.
    10. Kathryn Harrison, 2020. "Political Institutions and Supply-Side Climate Politics: Lessons from Coal Ports in Canada and the United States," Global Environmental Politics, MIT Press, vol. 20(4), pages 51-72, Autumn.
    11. Tenbensel, Tim & Burau, Viola, 2017. "Contrasting approaches to primary care performance governance in Denmark and New Zealand," Health Policy, Elsevier, vol. 121(8), pages 853-861.
    12. Fernando Martín-Mayoral & Juan Fernández Sastre, 2017. "Determinants of social spending in Latin America during and after the Washington consensus: a dynamic panel error-correction model analysis," Latin American Economic Review, Springer;Centro de Investigaciòn y Docencia Económica (CIDE), vol. 26(1), pages 1-32, December.
    13. Joan Costa-i-Font & Valentina Zigante, 2014. "The Choice Agenda' in European Health Systems: The Role of 'Middle Class Demands," LEQS – LSE 'Europe in Question' Discussion Paper Series 82, European Institute, LSE.
    14. Meltem Aran & Claudia Rokx, 2014. "Turkey on the Way of Universal Health Coverage Through the Health Transformation Program (2003-2013)," Health, Nutrition and Population (HNP) Discussion Paper Series 91326, The World Bank.
    15. Matthew Lockwood, 2022. "Policy feedback and institutional context in energy transitions," Policy Sciences, Springer;Society of Policy Sciences, vol. 55(3), pages 487-507, September.

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