Welfare with or without Growth? Potential Lessons from the German Healthcare System

Abstract

This article is meant to be a contribution to the debate on growth and welfare. Its argument is based on results of a Grounded Theory study about the German healthcare system, which suggests that the core of the healthcare system can be expressed by two abstract basic ideas that are contradictory and yet dependent on each other. The implications of the results, both for future research on the healthcare system and for the debate on growth and welfare, are discussed. As a final suggestion, "sustainability" is proposed as a concept that could potentially resolve the debate.

Dimensions, Dialectic, Discourse. Three Political Perspectives on the Sustainability of the German Healthcare System

“…The motivation of the second perspective of our research [ 9 , 10 ] was to have a closer look at the foundations of the German healthcare system by applying grounded theory methodology (GTM). The openness and the nature of GTM as an emergent method has the advantage that the researcher may adapt it flexibly to his or her specific needs [ 15 ].…”

“…The openness and the nature of GTM as an emergent method has the advantage that the researcher may adapt it flexibly to his or her specific needs [ 15 ]. For the purpose of our research, a total of 14 interviews with top-level health–political representatives was conducted (for a detailed description of the questions, see Appendix A of the article [ 9 ]). The interview partners were recruited based on the principle of theoretical sampling, in which the researchers assess potential research directions depending on the outcomes of the analysis of an interview, and select the following interview partners based on their suitability to contribute to the new direction [ 16 ].…”

“…Based on the interviews of the article by Fischer [ 9 ], health politics appeared to be a very intense struggle of the players, in which there is often a perceived separation between the winners and losers. In order to maximize their own share from the overall sum of money that is to be distributed, the stakeholders observed the actions of the other stakeholders carefully.…”

“…As a consequence, the concrete examples of contradictions described by the health–political stakeholders were abstracted and condensed to two basic ideas in the article “Welfare with or without growth? Potential lessons from the German healthcare system” [ 9 ]. The first basic idea, which was defined as an “exclusive basic idea”, described the relation to one’s self and the exclusive pursuit of one’s own benefit.…”

Decoding Sustainability in the Healthcare System. Teaching Students How to Problematize Complex Concepts

“…More important would be a common insurance including all professions"). In reality this might lead to a situation where polarized arguments stand next to each other without the possibility of a mutual consensus, as has happened in many cases of real health politics (Fischer 2016).…”