Programmatic Action in Times of Austerity. Elites' Competition and Health Sector Governance in France, Germany, the UK, and the USA (2008-2018)

ProAcTA完善并实施了计划性行动者框架，以在2008年至2018年期间在美国、英国、德国和法国测试以下假设：预算紧缩产生了反直觉的结果，它为有利于维持或扩大公共角色（政策保管人）的专门部门精英提供了手段和激励，以重申他们在国家内部的权威和自主权，与其他精英竞争，这些精英的计划利用紧缩的修辞来支持计划紧缩（紧缩主义者）。监护人和紧缩者都是程序性行为者的例子，他们的特征在我们之前的工作中得到了发展，并在本提案中进行了详细的定义。在此背景下，ProAcTA有助于检验一个更广泛的假设：方案参与者之间的权威竞争既提供了政策变化的内生动力，也为政策内容提供了必要的解释。程序化的参与者、管理者和紧缩者是理想的类型。程序化参与者框架有助于指定它们。通过系统的传记信息、深入的针对性访谈和详细的政策内容分析，我们确定了接近这些角色的集体行动者可以被识别到什么程度。我们特别要问：-直接参与改革或捍卫卫生政策项目的个人的社会和专业特征是什么？在什么情况下，他们联合起来成为相关和有影响力的集体行动者？-为应对紧缩的挑战，托管机构在多大程度上动员了以捍卫公共权威和（或）卫生系统可持续性为中心的论点，以及它们在与紧缩主义者的持续竞争中取得了多大的成功？-方案行动者调动了哪些新的或重新使用的政策工具？一个重要的调查领域是，在何种程度上可以在各国系统中建立与精英组成及其战略有关的功能等同，这些系统虽然都面临重大的预算压力，但在重大方面却各不相同。我们区分了两组预计会引导和约束精英行为的结构变量：-健康支付系统的结构和历史-紧缩政策的范围，时间和政治显著性。在详细说明这些时，我们试图超越社会福利系统的公认类型和自由主义和国家主义计划之间的二分法。这使我们能够重新审视社会政策紧缩的支持者和批评者所持有的假设，通过提交经验检验的前提，往往被认为是不言而喻的，即与紧缩相关的各种策略（预算削减，私有化，外包……）必然削弱了国家的范围和权威。

ProAcTA refines and implements the Programmatic Actor Framework to test the following hypothesis in the US, UK, Germany, and France between 2008 and 2018:In the health policy sector of western democracies, budgetary austerity has had the counter-intuitive result of providing specialized sectoral elites favorable to maintaining or expanding the public role (policy custodians) with the means and the incentive to reaffirm their own authority and autonomy within the state in competition with other elites whose program instrumentalizes the rhetoric of austerity in support of programmatic retrenchment (austerians). Both custodians and austerians are examples of programmatic actors, whose characteristics were developed in our prior work and are defined in detail in this proposal. In this context, ProAcTA contributes to the testing of a broader hypothesis:Competition for authority among programmatic actors provides both an endogenous dynamic of policy change and a necessary explanation for policy content.Programmatic actors, custodians, and austerians are ideal types. The Programmatic Actor Framework contributes to specifying them. Through systematic biographical information, in-depth targeted interviews, and detailed policy content analysis we determine to what extent collective actors approaching these roles can be identified. We ask in particular:- What are the social and professional characteristics of individuals directly involved with reforming or defending health policy programs? Under what circumstances do they coalesce into relevant and influential collective actors? - To what extent have arguments centered on the defense of public authority and/or the sustainability of health systems been mobilized by custodians in response to the challenge of austerity, and how successful have they been in the ongoing competition with austerians?- What new or repurposed policy instruments have been mobilized by programmatic actors?An important area of investigation is the extent to which functional equivalents relating both to the composition of elites and to their strategies can be established across national systems that, while all face significant budgetary pressure, vary on significant dimensions. We distinguish two clusters of structural variables that are expected to channel and constrain the actions of elites:- Structure and history of health payment systems- Extent, timing and political salience of austerity policiesIn specifying these, we seek to go beyond both the received typology of social welfare systems and the dichotomy between liberal and statist programs. This allows us to re-examine the assumptions held both by supporters of social policy retrenchment and its detractors by submitting to empirical testing the premise, too often taken as self-evident, that the various strategies linked to austerity (budget cuts, privatization, outsourcing...) have necessarily weakened the scope and authority of the state.