Background: Community initiatives for renewable energy are emerging across Europe but with varying numbers, success rates and strategies. A literature overview identifies structural, strategic and biophysical conditions for community success. Our analysis focuses on institutional structure, as we describe the variety between the Netherlands, Germany and Denmark, and place this within the institutional context of the policies, power structures and energy discourses of each country. Methods: We conducted a policy arrangements analysis with a series of semi-structured interviews, extensive content analysis of policy documents, media analysis and use of existing research, in a qualitative comparative analysis between the Netherlands, Germany and Denmark. Results: We demonstrate that the (evolving) institutional configuration of the energy sector strongly influences the available space for community initiative development. Denmark has a traditionally civil society-friendly energy sector, although opportunities for communities have decreased following the scaling up of production facilities. The Netherlands knows a predominantly market-oriented institutional arrangement that leaves little space for communities, but the potential for community based energy is increasingly recognized. In Germany, the typically state-dominant Energiewende strategy creates a window of opportunity for community initiatives that fit within the state policy. Conclusions: We conclude that the institutional arrangement of the energy policy subsystem can both constrain or enable community energy projects. Decentralization appears to be one of the most important characteristics of the general institutional development and generally increases the institutional space for local (community) players. The alignment of discourses across government levels and actors is one of the important enabling features of an energy system, as it provides the stability and predictability of the system that enables communities to engage in renewable energy projects.

In this article we analyze the evolution of market-oriented health care reforms in the Netherlands. We argue that these reforms can be characterized as policy learning within and between competing policy programs. Policy learning denotes the process by which policy makers and stakeholders deliberately adjust the goals, rules, and techniques of a given policy in response to past experiences and new information. We discern three distinctive periods. During the first period (1988-1994), the prevailing corporatist and etatist policy programs were seriously challenged by the proponents of a new market-oriented program. But when it came to political decision making and implementation, the market-oriented program soon lost its impetus because it was technically too complex and could not provide short-term solutions to meet the urgent need for cost containment. During the second period (1994-2000), the etatist program regained its previously dominant position. In parallel to a strengthening of supply and price controls, however, the government also persevered in creating the technical and institutional preconditions for regulated competition. Moreover, public discontent over waiting lists and the call for more autonomy by individual providers and insurers strengthened the alliance in favor of regulated competition. This led to the revival of the market-oriented program in a 2001 reform plan. We conclude that the odds of these new post-2001 reforms succeeding are substantially higher than in the first period due to the technical and institutional adjustments that have taken place in the past decade.

Seventy six senior academics from 11 countries invite The BMJ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

If public health is the field that diagnoses and strives to cure social ills, then understanding political causes and cures for health problems should be an intrinsic part of the field. In this article, we argue that there is no support for the simple and common, implicit model of politics in which scientific evidence plus political will produces healthy policies. Efforts to improve the translation of evidence into policy such as knowledge transfer work only under certain circumstances. These circumstances are frequently political, and to be understood through systematic inquiry into basic features of the political economy such as institutions, partisanship and the organization of labour markets.

: Although choice may be seen as an end in itself, the papers included in this special issue of Health Economics, Policy and Law, examine choice policies in European systems of health care, which aim to be effective instruments for ameliorating the systemic pressures from the iron triangle of equity, efficiency, and cost. Three papers consider the nature of differences between and within countries following the Beveridge and Bismarck models of financing and organising the delivery of care, and how choices are changing within different systems. Within countries following the Beveridge model, current policies in England, Denmark and Sweden emphasise increasing patient choice of provider. Within countries following the Bismarck model, current policies in France and Germany seek to restrict choice of specialists by introducing 'soft' gatekeeping; and in the Netherlands there is a system of managed competition with choice of insurer that, in principle, allows insurers to contract selectively

Housing is an area in which the active involvement of citizens in the provision of services has the potential to enrich individual lifestyles, local communities and the organisations providing housing, regardless of whether public, private for-profit or non-profit. Yet in current housing markets, housing tends to be purely individual, in the form of home ownership, or collectively managed through social rented housing. The article explores the conditions under which co-production in this field could be successful, as an alternative model. The analysis, which draws upon the work of Ostrom, is based on empirical fieldwork carried out among German housing cooperatives. As it turns out, successful co-production depends primarily on the long-term maintenance of group boundaries and specific trajectories of organisational development. This can make co-production an attractive model for specific social groups, but there are drawbacks: it also tends to lead to limited use of the invested capital and an inward orientation.Résumé Logement est une zone dans laquelle la participation active des citoyens dans la prestation de services a le potentiel d'enrichir les modes de vie individuels, collectivités locales et les organismes de fourniture de logements, peu importe si le public, privé à but lucratif ou à but non lucratif. Encore dans les marchés du logement, logement tend à être purement individuelle, sous la forme d'accession à la propriété ou gérés collectivement par l'entremise de logement locatif social. Cet article explore les conditions en vertu de laquelle coproduction dans ce domaine pourrait être couronnée de succès, comme un modèle alternatif. L'analyse, qui s'inspire des travaux de Ostrom, repose sur empirique sur le terrain réalisé auprès de coopératives de logement allemand. Il s'avère que, coproduction réussie repose principalement sur le maintien à long terme de limites de groupe et des trajectoires Resumen La vivienda es un área en la cual la participación activa de los ciudadanos en la prestación de servicios tiene el potencial para enriquecer los estilos de vida individuales, las comunidades locales y las organizaciones proporcionar alojamiento, independientemente de si es público, privado con fines de lucro o sin fines de lucro. Aún en los actuales mercados de la vivienda, vivienda tiende a ser puramente individual, en forma de propiedad de la vivienda, o colectivamente gestionada a través de viviendas sociales de alquiler. El artículo explora las condiciones bajo las cual coproducción en este campo podrían tener éxito, como un modelo alternativo. El análisis, que se basa en el trabajo de Ostrom, se basa en campo empírica llevada a cabo entre las cooperativas de vivienda alemán. Como resulta, coproducción exitoso depende principalmente en el mantenimiento a largo plazo de las fronteras del grupo y trayectorias específicas de desarrollo organizacional. Esto puede hacer coproducción un modelo atractivo para determinados grupos sociales, pero hay desventajas: también tiende a conducir a un uso lim...

Background Social determinants of health (SDoH) are known to have a large impact on health outcomes, but their effects are difficult to make visible. They are part of complex systems of variables largely indirect effects on multiple levels, constituting so-called wicked problems. This study describes a participatory approach using group model building (GMB) with stakeholders, in order to develop a qualitative causal model of the health effects of SDoH, taking poverty and debt in the Dutch city of Utrecht as a case study. Methods With GMB we utilised the perspective of stakeholders who are directly involved in policy and practice regarding poverty, debt, and/or health. This was done using system dynamic modelling, in three interactive sessions lasting three hours each. In these sessions, they constructed a model, resulting in a system of variables with causal relationships and feedback loops. Subsequently, the results of these GMB sessions were compared to scientific literature and reviewed by a panel of researchers with extensive experience in relevant scientific fields. Results The resulting model contains 71 causal relationships between 39 variables, 29 of which are present in feedback loops. The variables of participation in society, stress, shame, social contacts and use of services/provisions appear to hold prominent roles in the model’s mechanisms. Most of the relationships in the model are supported by scientific literature. The researchers reviewing the model in the scientific meeting agreed that the vast majority of relationships would concur with scientific knowledge, but that the model constructed by the stakeholders consists mostly of individual-level factors, while important conditions usually relate to systemic variables. Conclusions Building a model with GMB helps grasp the complex situation of a wicked problem, for which it is unlikely that its interrelationships result in a fully intuitive understanding with linear mechanisms. Using this approach, effects of SDoH can be made visible and the body of evidence expanded. Importantly, it elicits stakeholders’ perspectives on a complex reality and offers a non-arbitrary way of formulating the model structure. This qualitative model is also well suited to serve as conceptual input for a quantitative model, which can be used to test and estimate the relationships.

The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of ‘tact’, we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning public health purposes and installing socio-economic policies to soften societal impact. However, when the crisis evolved into a more enduring one, a more contested policy arena emerged in which decision-makers had a hard time composing and defending a united decision-making strategy. Measures have become increasingly debated on all policy levels as well as among experts, and conflicts are widely covered in the Dutch media. With the 2021 elections ahead, this means an additional test of the resilience of the Dutch socio-political and health care systems.