Healthcare Reforms and Fiscal Discipline in Europe: Responsibility or Responsiveness?

Abstract

This paper asks how governments across Europe have responded to the dilemma between financialresponsibility and political responsiveness against the background of heightened fiscal pressure.Focusing on the domestic politics of healthcare reforms in four contrasted cases (England, France,Hungary, and Ireland), we investigate how governments frame and legitimize these reforms. Wefind that references to input legitimacy vary greatly according to prevailing values of governmentsand party politics in the respective national realms. With regard to output legitimacy, efficiency andfinancial sustainability tend to prevail over concerns related to quality in those countries that aremore affected by debt. Across all cases, governments rely on an instrumentalist conception ofthroughput legitimacy, meaning that they use consultation with different stakeholders as a way toprevent adverse politicization and to support their framing of the reforms. ; SCOPUS: ar.j ; info:eu-repo/semantics/published