Humboldt-Universität zu Berlin - Department of Social Sciences - Berlin Graduate School of Social Science

Guergana Stolarov-Demuth

Guergana Stolarov-Demuth

BGSS Generation 2013


Graduate School of Norh American Studies



Interest Groups Politics, Agendas, and Institutions: Comparative Analysis of Health Care Reforms in Switzerland, the Netherlands, and the United States 



After a long period of policy stability, major health care reforms were introduced in Switzerland (1996), the Netherlands (2006), and the United States (2010). Previous to reform, the considerable portion of private health insurance in all three health care systems has contributed to rising health care costs and diminishing access to health insurance. It also determined the strong power position of traditionally reform hostile private interest groups. Despite the similar problem pressures and strong influence of interest groups, the reforms differ both in their direction and magnitude.

The Swiss health care reform marked a system-shift towards “an enlarged role for the federal state in social policy” (Obinger 2005 et al.:179). The Dutch health care reform led to a general restructuring and denoted a “push towards privatization” (Okma 2009:1). The health care reform in the United States was rather limited to “layering”.  It “followed a well-established template in American policy-making of delegated responsibility for publicly funded social welfare programs to private entities and state governments” (Morgan, Campbell 2011:4).

Based on these observations, in my dissertation I address two research questions. First, what explains the passage, direction, and magnitude of major health care reforms and the eventual occurrence of paradigm shifts after a long period of policy stability? Second, what explains the convergence of policy substance (e.g. some form of managed competition and individual mandate) between the three cases? In order to answer these questions, I will adopt a new-institutionalism approach and focus on the interaction between (1) interest groups’ preferences and strategies (agency-based and ideational causes) and (2) institutional structures (structuring and filtering causes).