7 - Germany: Dominance of Individual Health Care and Decoupling from Public Health

Summary

This chapter analyzes the coevolution of health care and public health, in Germany. The case study examines the coupling of the two sectors against a backdrop of the combination of unified government on the one hand and low professionalism and corporatist interest intermediation on the other. My theoretical priors lead me to expect to find non-coupling of health care and public health, even if the contextual conditions are favorable to sectoral responsiveness. The results show the political activity of the medical profession did not focus on broader health issues, i.e, it did not give non-medical public health policies a high political priority. Nevertheless, there was policy integration of health care and public health since the policymakers followed the example of other countries. Different than hypothesized, the analysis demonstrates that the federal structure of the Germany resulted in institutional fragmentation of the two sectors – despite the comparatively centralized structure of the German state. Nevertheless, there was policy integration of health care and public health since German policymakers followed the example of other countries.