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

This paper asks how governments across Europe have responded to the dilemma between financial responsibility 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. We find that references to input legitimacy vary greatly according to prevailing values of governments and party politics in the respective national realms. With regard to output legitimacy, efficiency and financial sustainability tend to prevail over concerns related to quality in those countries that are more affected by debt. Across all cases, governments rely on an instrumentalist conception of throughput legitimacy, meaning that they use consultation with different stakeholders as a way to prevent adverse politicization and to support their framing of the reforms.