IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v150y2024ics0168851024001878.html
   My bibliography  Save this article

German centralization strategy during COVID-19: Continuing or interrupting a trend?

Author

Listed:
  • Niehaus, Ines Marina
  • Lehr, Andreas
  • Kaiser, André
  • Müller, Helena Sophie
  • Kuntz, Ludwig

Abstract

In response to the COVID-19 pandemic, many countries applied centralization strategies to the distribution of power between national government and regional/local governments over responsibility for regulatory tasks. As a result, health-policy decision-making competences were shifted from the regional level to the national level (vertical shift of decision-making competences). This centralization trend for the purpose of infection control is evident in Germany. We conducted a quantitative and qualitative analysis of health-policy regulatory measures (March 2018 to March 2020) in order to investigate whether the vertical shift in decision-making competences was already a trend in Germany before the COVID-19 pandemic and beyond infection control. Our results show that the centralization strategy observed during COVID-19 does not continue a trend. Before the COVID-19 pandemic, what was most important was the distribution of power at national level between government and non-government institutions (horizontal allocation of decision-making competences). This long-term trend strengthens the decision-making competences of government institutions and weakens non-government institutions.

Suggested Citation

  • Niehaus, Ines Marina & Lehr, Andreas & Kaiser, André & Müller, Helena Sophie & Kuntz, Ludwig, 2024. "German centralization strategy during COVID-19: Continuing or interrupting a trend?," Health Policy, Elsevier, vol. 150(C).
  • Handle: RePEc:eee:hepoli:v:150:y:2024:i:c:s0168851024001878
    DOI: 10.1016/j.healthpol.2024.105177
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851024001878
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.healthpol.2024.105177?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Tomas Bergström & Sabine Kuhlmann & Martin Laffin & Ellen Wayenberg, 2022. "Special issue on comparative intergovernmental relations and the pandemic: how European devolved governments responded to a public health crisis," Local Government Studies, Taylor & Francis Journals, vol. 48(2), pages 179-190, March.
    2. Davide Vampa, 2021. "COVID-19 and Territorial Policy Dynamics in Western Europe: Comparing France, Spain, Italy, Germany, and the United Kingdom," Publius: The Journal of Federalism, CSF Associates Inc., vol. 51(4), pages 601-626.
    3. André Kaiser & Stephan Vogel, 2019. "Dynamic De/Centralization in Germany, 1949–2010," Publius: The Journal of Federalism, CSF Associates Inc., vol. 49(1), pages 84-111.
    4. Greer, Scott L. & Dubin, Kenneth A. & Falkenbach, Michelle & Jarman, Holly & Trump, Benjamin D., 2023. "Alignment and authority: Federalism, social policy, and COVID-19 response," Health Policy, Elsevier, vol. 127(C), pages 12-18.
    5. Valérie Paris & Marion Devaux & Lihan Wei, 2010. "Health Systems Institutional Characteristics: A Survey of 29 OECD Countries," OECD Health Working Papers 50, OECD Publishing.
    6. Adolph, Christopher & Greer, Scott L. & Massard da Fonseca, Elize, 2012. "Allocation of authority in European health policy," Social Science & Medicine, Elsevier, vol. 75(9), pages 1595-1603.
    7. Sabine Kuhlmann & Jochen Franzke, 2022. "Multi-level responses to COVID-19: crisis coordination in Germany from an intergovernmental perspective," Local Government Studies, Taylor & Francis Journals, vol. 48(2), pages 312-334, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Godager, Geir & Iversen, Tor & Ma, Ching-to Albert, 2015. "Competition, gatekeeping, and health care access," Journal of Health Economics, Elsevier, vol. 39(C), pages 159-170.
    2. Nicholas Bloom & Renata Lemos & Raffaella Sadun & John Van Reenen, 2020. "Healthy Business? Managerial Education and Management in Health Care," The Review of Economics and Statistics, MIT Press, vol. 102(3), pages 506-517, July.
    3. Baird, Katherine Elizabeth, 2016. "The incidence of high medical expenses by health status in seven developed countries," Health Policy, Elsevier, vol. 120(1), pages 26-34.
    4. Tobias Arnold & Sean Mueller & Adrian Vatter, 2021. "Shock or Design: What Drives Fiscal De/Centralization? A Comparative Analysis of Twenty-Nine OECD Countries, 1995–2017," Publius: The Journal of Federalism, CSF Associates Inc., vol. 51(1), pages 1-26.
    5. Sergey Shishkin & Alexandra Burdyak & Elena Potapchik, 2013. "Patient choice in the post-Semashko health care system," HSE Working papers WP BRP 09/PA/2013, National Research University Higher School of Economics.
    6. Lukas Breide & Oliver Budzinski & Thomas Grebel & Juliane Mendelsohn, 2025. "Forerunners vs. latecomers—institutional competition in the German federalism during the COVID crisis," European Journal of Law and Economics, Springer, vol. 59(1), pages 101-132, February.
    7. Kihlström, Laura & Siemes, Lea & Huhtakangas, Moona & Keskimäki, Ilmo & Tynkkynen, Liina-Kaisa, 2023. "Power and politics in a pandemic: Insights from Finnish health system leaders during COVID-19," Social Science & Medicine, Elsevier, vol. 321(C).
    8. repec:eur:ejnmjr:8 is not listed on IDEAS
    9. Martini, Gianmaria & Levaggi, Rosella & Spinelli, Daniele, 2022. "Is there a bias in patient choices for hospital care? Evidence from three Italian regional health systems," Health Policy, Elsevier, vol. 126(7), pages 668-679.
    10. Titeca, Hannes, 2016. "Healthcare Spending: The Role of Healthcare Institutions from an International Perspective," MPRA Paper 73678, University Library of Munich, Germany.
    11. Adolph, Christopher & Greer, Scott L. & Massard da Fonseca, Elize, 2012. "Allocation of authority in European health policy," Social Science & Medicine, Elsevier, vol. 75(9), pages 1595-1603.
    12. Igor Sheiman & Vladimir Shevski, 2013. "Health care integration in the Russian federation: conceptual framework, evaluation, and new instruments," HSE Working papers WP BRP 10/PA/2013, National Research University Higher School of Economics.
    13. Levaggi, Laura & Levaggi, Rosella, 2023. "Competition in the provision of hospital care: Are mixed markets a valid alternative?," Economic Modelling, Elsevier, vol. 127(C).
    14. Gisele Teixeira Braun & Luis Gomes Centeno, 2018. "Health Systems," CFP Occasional Papers 01/2018, Portuguese Public Finance Council.
    15. Christine de la Maisonneuve & Rodrigo Moreno‐Serra & Fabrice Murtin & Joaquim Oliveira Martins, 2017. "The Role of Policy and Institutions on Health Spending," Health Economics, John Wiley & Sons, Ltd., vol. 26(7), pages 834-843, July.
    16. André, Christine, 2015. "Les systèmes de santé européens en longue période," Revue de la Régulation - Capitalisme, institutions, pouvoirs, Association Recherche et Régulation, vol. 17.
    17. Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, R.C.M.H., 2017. "Cost-Sharing Design Matters : A Comparison of the Rebate and Deductible in Healthcare," Other publications TiSEM 67163c04-3d3b-499c-882c-d, Tilburg University, School of Economics and Management.
    18. Terraneo, Marco, 2015. "Inequities in health care utilization by people aged 50+: Evidence from 12 European countries," Social Science & Medicine, Elsevier, vol. 126(C), pages 154-163.
    19. Razi Farukh & Anna Kerkhof & Jonas Loebbing, 2020. "Inefficiency and Regulation in Credence Goods Markets with Altruistic Experts," Working Paper Series in Economics 102, University of Cologne, Department of Economics.
    20. Qiongzhi Liu & Jing Ren, 2023. "Local Fiscal Pressure and Enterprise Environmental Protection Investment under COVID-19: Evidence from China," Sustainability, MDPI, vol. 15(6), pages 1-20, March.
    21. Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, R.C.M.H., 2017. "Cost-Sharing Design Matters : A Comparison of the Rebate and Deductible in Healthcare," Discussion Paper 2017-049, Tilburg University, Center for Economic Research.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:150:y:2024:i:c:s0168851024001878. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.