Guergana Stolarova

PhD Candidate

What do the welfare states have in common in managing the distribution and the control of health care costs? Universal mandatory health insurance, managed competition, and the boundaries of the regulatory state

(Comparative analysis of Switzerland, the Netherlands, and the US)

The health care systems in the OECD countries are facing growing demographic and economic pressures, posing a major challenge to contemporary politics. As a response to these pressures, in various industrialized countries, comprehensive health care reforms were introduced, aiming at controlling costs and ensuring universal coverage for the patients.

In order to understand these recent transformations, a comparison is inevitable. Therefore, in my dissertation project, I am analyzing three countries, Switzerland, the Netherlands, and the US, in which (1) comprehensive health care reforms were introduced in the recent years, and (2) private health insurance played a major role previous to the reform, posing similar constraints both to the control of health care costs and to the access to health insurance.

In my dissertation project, I will address the following questions:

(1) Why health care reform now? What constellations and dynamics of political actors and institutions enabled the passage of a comprehensive reform package and made the change possible? This question is especially interesting in the case of the US, which is unique due to a long path of reform struggles over health care.

(2) What types of cost control and distribution policies could be identified in the recent health care reforms in these countries and how are those policy choices deriving from the particular institutional context, the predominant modes of governance, and the reform dynamics?

(3) How is the level of state involvement changing in health care systems relying predominantly on market mechanisms and negotiation in the supply of health care? Could one observe a convergence between these systems and why is that so?

Dahlem Research School
Deutsche Forschungsgemeinschaft