Chapter 11 pulls the various strands of the book together. It summarizes the findings of the cases, in both tabular and textual format, and draws comparative observations across them.

These comparisons allow us to draw some conclusions about the consequences of different types of strategies of scale and paces: for the coherence of policy frameworks, the levels of conflict involved in their adoption and implementation, and the durability of the arrangements they put in place. This final chapter also summarizes the changes (or lack thereof) in the policy logics of each national system, and draws comparative lessons about the implications of market-oriented reforms – including their counterintuitive propensity to lead to a shift in the functional role of the state but not a diminution of its influence, and to an overall increase in the weight of social control of behavior through various institutional means.

Methodologically, the chapter reflects on the challenges as well as the gains to be made in attempting to understand the assumptive worlds of decision-makers. Such an approach requires extensive review of documentary evidence and thorough and careful interviewing. It also requires a testing of the evidence against various counter-hypotheses – a corrective in which comparison across cases is invaluable.

To further test a conceptual framework honed through its application to the ten principal cases in the book, I use it to analyze one final case: that of German health care in the millennial period, and particularly the comparisons and contrasts between the German case and that of its Dutch neighbour. Finally, I consider very briefly how my framework might be applied to other cases in health care and in other policy arenas, as an invitation to others who might wish to pick it up from here.

Return to "To My Readers"