Born in the USA? A Comparison of "Inspired" Health Care Reforms in Germany and France

Abstract

Context: Despite numerous examples of health policy transfer in Western health systems, the nature of such "inspired"reforms has received little detailed attention. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms using the theoretical frameworks of transfer and translation. Methods: The design is based on a comparative case study: The introduction of disease management programs (DMPs) for diabetes in Germany in 2002 and in France in 2008, drawing on a literature review and semistructured interviews. Findings: In introducing itsDMP, Germany chose and combined several components in a process of selective borrowing, while France opted for copying a specific foreign program and adapting it. Such differences in process are linked to distinct system structures, in particular the setup of health insurance and the representation of physicians. Furthermore, the displayed versus actual degree of inspiration varied significantly, with a branding strategy in Germany (high display of foreign influence) and the inverse picture in France (high degree of actual inspiration). Conclusions: This analysis has applied the dual perspective of transfer and translation. Both perspectives proved complementary and necessary, and translation appeared as a main determinant of implementation success.