Ensuring medical care in disadvantaged regions. An international comparison of policy strategies in Germany, France, England and Sweden.

确保充足的门诊医疗服务是发达福利国家公共政策的核心任务。虽然医生密度在增加，但医疗保健不足的地区数量仍在继续增加。从中期来看，这些问题预计将进一步恶化。这项研究项目将比较选定的西欧福利国家(德国、法国、英国、瑞典)从2000年到现在解决这一问题的政治策略。研究集中于以下问题：1.为解决有关时期现有或威胁到的门诊医疗服务供应不足的问题，所追求的目标和选择的工具是什么？2.解释各自目标制定和工具选择的因素是什么？3.政策制定在多大程度上伴随着各自医疗保健制度的变化，特别是在监管和服务提供结构方面？第一个问题通过探索来解决与政策相关的经验知识。在现有数据和文件的基础上，将制定问题认识和政策制定的类型学。第二个问题旨在通过定性的实证分析和对变化的解释，获得关于比较国家活动和医疗保健系统研究的理论知识。在理论假设的基础上，将分析国家卫生保健系统与政治战略选择之间的相互关联的影响。我们特别感兴趣的是利益相关者的角色、问题认知、他们的权力资源以及各自医疗保健系统的制度结构。第三个问题集中在医疗保健制度的改革上。我们分析了在个人卫生保健系统中，目标的制定和对门诊医疗设施的区域性监管工具的选择是否创造了新的监管和制度结构(杂交)，或者问题的解决是否仍然留在他们历史上发展起来的监管和制度框架内(路径依赖)。因此，通过国际比较，将分析卫生保健系统的分歧或趋同问题。这项定性研究在方法上以文件(专家报告、政策文件、议会辩论等)的内容分析为基础。关于改革政策和专家访谈。国家一级的战略分析将得到区域案例研究的补充。除了获得科学知识外，这一研究项目的发现有望在实际和政治方面提供好处。预计这将提高人们对国家政策转移的看法。

Ensuring adequate outpatient medical care is a core task of public policy in advanced welfare states. Though the physicians density is increasing the number of regions with insufficient availability of medical care continues to grow. In the medium term, these problems are predicted to exacerbate. This research project is going to compare the political strategies of selected West European welfare states (Germany, France, Great Britain, Sweden) tackling this problem from 2000 to the present. Research focusses the following questions: 1. What are the goals pursued, and instruments selected, in order to tackle the problem of existing or threatening insufficient availability of outpatient medical care in the period in question? 2. What are the factors which explain the respective goal formulation and choice of instruments? 3. In how far is the policy formulation accompanied by a change of the respective health care systems, especially with regard to regulation and the structure of service delivery? The first question addresses the policy-related empirical knowledge by exploration. On the basis of data and documents available a typology of problem perception and policy formulation is to be developed. The second question aims at gaining theoretical knowledge on comparative state activity and health care systems research by qualitative empirical analysis und explanation of change. On the basis of hypotheses derived from theory the inter-related effects between the national health care systems and the selection of political strategies will be analyzed. Our particular interest is the question for the role of the stakeholders problem perception, their power resources and the institutional structures of the respective health care system. The third question focuses on the change of health care systems. We analyze whether the goal formulation and the choice of instruments regionally regulating outpatient medical facilities in the individual health care systems create new regulative und institutional structures (hybridization) or whether problem-solving remains within their regulative and institutional framework historically developed (path dependency). Thus, by international comparison the problem of divergence or convergence of health care systems will be analyzed. This qualitative study is methodologically based on the content analysis of documents (expert reports, policy papers, parliamentary debates etc.) concerning reform policies and expert interviews. The analysis of strategies at the national level will be supplemented by regional case studies. Apart from the scientific knowledge gain the findings of this research project promise to provide benefits both in practical and political terms. It is expected to heighten perception for national policy transfer.