The Politics of Territorial Inequalities in Access to Medical Care Germany, France, England, and Sweden compared

Ensuring equal access to health care is a one of the core tasks of European welfare states. However some of them are facing growing difficulties to allow for adequate access to health care in disadvantaged (i.e. isolated and economically weak) regions. Thus, insufficient availability of medical care in those areas is a subject of political concern. Our paper focuses on the emergence of this issue and asks how it has been taken into account by political actors in four European countries (Germany, France, England, and Sweden). We propose an analytical framework articulating the publicization and the politization processes of territorial inequalities in access to medical care. The paper is based on the systematic analysis of public reports (expert reports, institutional reports and preparatory reports) and parliamentary debates. Additionally we use interviews with experts, institutional actors, interest groups and politicians. We also include the media coverage of this issue. Our paper is developed in the context of an international research project comparing national policy strategies for the supply of outpatient medical care in disadvantaged regions, in four European countries (Germany, France, England, and Sweden). These countries represent two main types of health systems (national health service, health insurance system) accounting for a rather centralised (England, France) and a rather de-centralised (Germany, Sweden) welfare state. The project is co-funded by the German Science Foundation (Deutsche Forschungsgemeinschaft, DFG) and the French National Research Agency (Agence nationale de la recherche, ANR). We aim at analyzing how problems are being perceived and attempts for problem-solving regulation are being designed in these countries. Thus our project seeks to explore the change of the regulatory und institutional structures in different European health care systems embedded in different European welfare states.