The (mis)fit of policy programs to political institutions and its influence on programmatic action – How crisis has differently hit French and German health policy

Abstract

The Programmatic Action Framework (PAF) is a relatively new theoretical perspective that adds a complementary lens to the explanation of policy processes and policy change. Yet, a key requirement of a valid policy process framework is its capacity to be proven wrong. Besides the empirical cases that provide evidence for the occurrence of programmatic action, it is necessary to present examples in which programmatic action did not occur, and to explain why this is the case. Proceeding from the observation that programmatic groups and policy programs existed in French and German health policy throughout the 1990s, this contribution answers the question why in 2020, programmatic action is still present in France but not in Germany and why the German policy program did not survive the financial crisis of 2008. It argues that misfit to pre‐existing institutional logics and changing institutional logics in the course of programmatic action hinder program success.

Programmatic action in Chinese health policy—The making and design of “Healthy China 2030”

“…Hassenteufel et al (2010) examined health policy in the United Kingdom, Germany, France, and Spain. Hornung (2021) analyzes health policy in France and Germany. Davidian (2021) applied the PAF to health reform in Brazil.…”

“…The PAF proposes that goal attainment is shaped by program coherence, i.e., alignment between policy goals, objectives, and instruments, as well as institutional congruence, i.e., alignment between the program and existing institutions. In addition to coherence and institutional congruence, the PAF includes a third aspect that increases the likelihood of success, namely the responsiveness of the program to existing and emerging challenges within the policy subsystem (Hornung, 2021).…”

“…Therefore, rather than testing all existing PAF hypotheses in China, we use the framework to evaluate the potential of program success. It is important to evaluate the potential for policy success because success shapes the power position of the programmatic group promoting a specific program (Hornung, 2021). We focus our analysis of Healthy China 2030 on five PAF aspects of policy program success (Hornung, 2021), namely (1) program coherence, i.e., alignment between policy goals, objectives, and instruments, (2) institutional congruence, i.e., alignment between the program and existing institutions, (3) connectivity, i.e., the ability of the policy program to provide an anchor for identification of actors that appear relevant in the existing structures, (4) responsiveness, i.e., the extent to which the program meets broader existing and emerging challenges within the policy subsystem, and (5) program fit, i.e., whether the program provides a narrative that fits into and is responsive to the dominant national mood.…”

“…So far, the PAF has only been applied to democracies. The framework was originally developed to explain policy change and stability in France (Hassenteufel et al, 2010) and has subsequently been refined and applied to other countries, including the United Kingdom, Germany, Spain and Brazil (Davidian, 2021; Faure, 2020; Hassenteufel et al, 2010; Hornung, 2021). Bandelow and Hornung (2019) combine the PAF with narrative analysis to examine changes in labor market policies in France and Germany.…”

Public Policy Research—Born in the USA, at Home in the World?

“…In public policy, it became a major tool of the Programmatic Action Framework (PAF), an approach that has its origins in French elite research (Bandelow and Hornung 2020 ; Hassenteufel et al. 2010 ; Hornung 2022 ). Even though the psychological core of the SIPP perspective can be argued to be universal, political conditions may influence the relevance and salience of certain identities.…”