Is Service Quality a Driver of the Regulatory Welfare State? Policies for Health Services in Germany and France

Abstract

The article analyzes the design and development of health services in Germany and France—two countries with similar welfare states but with striking differences in their national regulatory styles. Using these comparative cases, I show how the interplay of long-term institutional factors and short-term political factors shaped the establishment and development of these regulatory welfare states’ (RWS) social services. Specifically, I argue that the discovery of service quality in the 1990s had the potential to accelerate RWS development. In Germany, characterized by a corporatist state tradition and a cooperative regulatory style, the political debate on quality (either as a parameter of competition or as a concept for the professional consolidation of service production) had a greater influence on the design of the national quality regulation system (goals, instruments, processes, institutions) than in France, which is characterized by a state-centered Napoleonic tradition and a directive regulatory style.