Social Science and Public Policy

Richard Freeman

backpublications - comparative health policy

Health care systems and the problem of classification
Freeman, R and Frisina, L

Classification is integral to comparison. The aim of this paper is to reflect on the nature, purpose and limits of classification in comparative health policy. We begin by describing the role of classification in comparative research design, discussing Weber’s concept of the ‘‘ideal type’’ and drawing on the sociology of scientific knowledge to reflect on classification as an essentially social and uncertain process. In the sections which follow, we present an outline history of the classification of health systems, identifying a 'normal science' of comparative studies of health policy and exploring a number of theoretical, conceptual and methodological issues which arise from it.

Publication Type: journal paper      Source: Journal of Comparative Policy Analysis 12 (1) 163-178
Date: 2010       Link:

Freeman, R and Rothgang, H

This paper reviews comparative research on health policy in OECD countries, outlining the origins and development of health policy in the modern state and pointing to the different ways that development has been understood by welfare state scholars. We describe different standard forms of health system, discussing the ways health care is paid for, provided and regulated in advanced industrial countries, and comment on the emergence of a new domain of international and global health.

Publication Type: chapter in book      Source: Obinger, H, Pierson, C, Castles, F G, Leibfried, S and Lewis, J (eds) Oxford Handbook of the Welfare State, Oxford: Oxford UP
Date: 2010       Link:

Comparative Studies and the Politics of Modern Medical Care
Marmor, T, Freeman, R and Okma, K (eds)

This new collection explores recent patterns in health care regulation, financing, and delivery across countries. Wide-ranging essays cover both key countries (Canada, Germany, Holland, the United Kingdom and the United States) and key issues, including primary care, hospital care, long-term care, pharmaceutical policy, and private health insurance. Respective authors pay close attention throughout to the ways in which cross-national, comparative research informs national policy debates across the world.

Publication Type: book      Source: New Haven: Yale UP
Date: 2009       Link:

Comparing health systems

This chapter reviews the modes and functions of cross-national comparison in health services research and policy.

Publication Type: chapter in book      Source: Mullner, R (ed) Encyclopaedia of Health Services Research, Thousand Oaks, CA: Sage
Date: 2009       Link:

Marmor, T R, Freeman, R and Okma, K

Publication Type: chapter in book      Source: Marmor, T R, Freeman, R and Okma, K (eds) Comparative Studies and the Politics of Modern Medical Care, New Haven: Yale UP
Date: 2009       Link:

Pharmaceutical politics in OECD countries

Publication Type: chapter in book      Source: Marmor, T R, Freeman, R and Okma, K (eds) Comparative Studies and the Politics of Modern Medical Care, New Haven: Yale UP
Date: 2009       Link:


WHO, Mental Health, Europe
Freeman, R, Smith-Merry, J and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2009       Link:


The Fabrication, Circulation and Use of Knowledge-based Regulatory Instruments in European Countries
Afonso, N, Carvalho, L, Costa, E, Freeman, R, Smith-Merry, J and Sturdy, S

Publication Type: research report      Source: EC integrated project 028848-2 KNOWandPOL
Date: 2009       Link:

A National Health Service, by comparison

The National Health Service (NHS) has always been compared to other things, to other organizations and systems both at home and abroad. This paper explores those comparisons, beginning with the origins of national public health care in Lloyd George’s study of German social insurance, and ending with Gordon Brown’s claims for the NHS as ‘the best insurance policy in the world’. It considers the comparisons and contrasts made for and with the NHS at the time of its foundation and the comparison of state and market around 1990, before reviewing the contemporary function of comparison as form and basis of health governance. The paper presents three related patterns of thought: one prompted by encounter with the other, one sustained by metaphor and one developed in more formal, analytic comparison. It concludes by discussing why comparison itself is such a dangerous and contested thing.

Publication Type: journal paper      Source: Social History of Medicine 21 (3) 503–520
Date: 2008       Link:

Global health and the problem of governance

Publication Type: journal paper      Source: Harvard Health Policy Review 9 (1) 26-34
Date: 2008       Link:

Western Europe, health systems of
Freeman, R and Schmid, A

Publication Type: chapter in book      Source: Heggenhougen, K and Quah, S (eds) International Encyclopaedia of Public Health, vol 6 San Diego: Academic Press/Elsevier
Date: 2008       Link:

Comparative perspectives and policy learning
Marmor, T, Freeman, R and Okma, K

Publication Type: chapter in book      Source: Morone, J A, Litman, T J and Robins, L S (eds) Health Politics and Policy, London: Cengage Delmar Learning
Date: 2008       Link:

Saglik Politikalari Süricinde Ögrenme [Learning in health policy]

Publication Type: chapter in book      Source: Keyder, C, Üstündag, Agartan, T and Yoltar, C (eds) Avrupa'da ve Türkiye'de Saglik Politikalari. Reformlar, sorunlar, tartismalar, Istanbul: Iletisim Yayinlari
Date: 2007       Link:

The work the document does. Research, policy and equity in health

At the center of the politics of health equity, in many countries and circumstances, stands a signal report of research. This article is concerned with what might be described as the architecture of such documents, including how they are produced and organized and the relationships they demonstrate with others that parallel, precede, and succeed them. The article examines how scientific and political authority is established and comments on the evidence of cross-national learning that these documents reveal. It discusses differences in how the problem of health equity is constructed in different countries and how research findings are converted into policy recommendations. It begins to trace a process of implementation by noting how these documents are referred to and written about. The argument is that the politics of health equity are expressed or realized in the documents and reports, which are its principal vehicle. This is not to claim that there is no world beyond the text or that the world somehow is a text, but that to fully understand that world we must understand the text and the work it does.

Publication Type: journal paper      Source: Journal of Health Politics, Policy and Law 31 (1) 51-70
Date: 2006       Link: http://www.

Comparative perspectives and policy learning in the world of health care
Marmor, T R, Freeman, R and Okma, K

The main point of this article is to explore the methodological questions raised by weaknesses in international comparative work in the field of health policy. The core question is how competent learning from one nation to another can take place. The article argues that there is a considerable gap between the promise and the actual performance of comparative policy studies. Misdescription and superficiality are all too common. Unwarranted inferences, rhetorical distortion, and caricatures, all show up too regularly in comparative health policy scholarship and debates. The article first describes the context of the health and welfare state reform debates during the past three decades. In almost all industrialized democracies, rising medical expenditures exacerbated fiscal concerns about the affordability of the mature welfare state. In reaction to pressure for policy change in health care, policy makers looked abroad for promising solutions to domestic problems. The following section takes up the topic of cross-national policy learning. Then, it critically reviews recent debates about health care reforms and addresses the purposes, promises and pitfalls of comparative study in health policy. The next section categorizes existing comparative health policy literature to highlight the character, possibilities and limits of such work. The concluding section returns to the basic theme: the real promise of comparative scholarship and the quite mixed performance to date.

Publication Type: journal paper      Source: Journal of Comparative Policy Analysis 7 (4) 331-348
Date: 2005       Link:

Making sense of health politics through cross-national comparison: Odin Anderson's seminal essay
Freeman, R and Marmor, T R

Publication Type: journal paper      Source: Journal of Health Services Research and Policy 8 (3) 180-182
Date: 2003       Link:

The health care state in the information age

The computerization of the medical record has important implications for the governance of health care, and the importance of health care means that changes wrought there are indicative of changes in government as a whole. This paper draws on work in public policy, medical sociology and studies of science and technology, as well as on cross–national empirical research in Britain and France. It describes the recent development of information policy in health care as an exercise in state–building, realized specifically in the governance of the health professions. The paper concludes with a discussion of what is both new and not so new in the form and extent of state power which emerges.

Publication Type: journal paper      Source: Public Administration 80 (4) 751-767
Date: 2002       Link:


New Knowledge in New Settings: social learning in the health sector

Publication Type: research report      Source: European Science Foundation, Standing Committee for the Social Sciences
Date: 2001       Link: Knowledge in New Settings: social learning in the health sector

The politics of health in Europe

This is the first general comparative study of health policy and politics to focus on major countries of Western Europe: France, Germany, Italy, Sweden and the UK. It begins by identifying differences in arrangements for the finance, delivery and regulation of health care in different countries, explaining how health systems are to be understood as political entities. The book describes and accounts for the evolution of state intervention in the health sector before comparing and contrasting different kinds of systems. It examines recent changes in the organization of health care as well as recent challenges to public health, including policy responses to AIDS.

1 Health politics; 2 The health care state in Europe, 1880-1980; 3 National health services: Italy, Sweden and the UK; 4 Social insurance systems: France and Germany; 5 Reform and restructuring; 6 Doctors and states; 7 The users of health care; 8 Health, the public and public health

Publication Type: book      Source: Manchester: Manchester UP
Date: 2000

Reforming health care in Europe
Freeman, R and Moran, M

Publication Type: chapter in book      Source: Ferrera, M and Rhodes, M (eds) Recasting European Welfare States, London: Frank Cass
Date: 2000


Reforming health care in Europe
Freeman, R and Moran, M

Publication Type: journal paper      Source: West European Politics 23 (2) 35-58
Date: 2000       Link:

Institutions, states and cultures: health policy and politics in Europe

Publication Type: chapter in book      Source: Clasen, J (ed) Comparative Social Policy. Concepts, theories and methods, Oxford: Blackwell
Date: 1999       Link:,descCd-description.html


Policy Responses to AIDS in Europe
Bennett, R and Freeman, R

Publication Type: research report      Source: European Commission EUR 17789 - Research on bioethics - AIDS: Ethics, Justice and European Policy
Date: 1998

Competition in context: the politics of health care reform in Europe

The purpose of this paper is to provide a basis for exploring the relationship between competition and quality in health care by delineating the different institutional economic and political contexts in which pro-competitive reform was conceived and carried out in different European countries. It begins by distinguishing between national health services and social insurance systems, suggesting that different kinds of system generate different kinds of problem. Different patterns of reform in Italy, Sweden and the UK, and in France and Germany are then reviewed in turn. The paper shows how, since the end of the long boom, health systems in Europe have been exposed to a set of economic, political and ideological pressures. The way these were brought to bear meant that governments in those countries with national health services were much more disposed to radical, pro-competitive reform than others. For them, competition represented a way of managing resource constraint in an increasingly complex and demanding political environment; ideas about quality were marginal to their purpose. The paper then explores the application of competition in different contexts, first among providers and then among purchasers, for which the UK and Germany serve as examples in turn. In each case, competition is only made effective by new forms of managerial direction. Across systems, competition appears less clearly associated with quality than with political control.

Publication Type: journal paper      Source: International Journal for Quality in Health Care 10 (5) 395-401
Date: 1998       Link:

Prevention and government: health policy making in the United Kingdom and Germany

The gap between rhetoric and reality in health policy making for disease prevention services is well recognized. I do not try once more to close the gap, but rather argue that the rhetoric of prevention is politically significant. Beginning with an account of prevailing explanations of prevention in policy making, I explore the idea that prevention has a pervasive legitimacy in health politics. This affords opportunities for instrumental policy making by government. To this end, I concentrate on the relationship between disease prevention and health care delivery, discussing in detail the association between prevention and health care reform. My arguments are based on case studies of policy making in Germany and the United Kingdom. I discuss implications for understanding the core interests of government, physicians, and users with respect to prevention in health policy making. The concluding section offers comparative commentary on the role of disease prevention in health sector restructuring.

Publication Type: journal paper      Source: Journal of Health Politics, Policy and Law 20 (3) 745-765
Date: 1995       Link:

The politics of AIDS in Britain and Germany

Publication Type: chapter in book      Source: Aggleton, P, Davies, P and Hart, G (eds) AIDS: Rights, Risk and Reason, papers from the fifth conference on Social Aspects of AIDS, Brighton: Falmer
Date: 1992


Governing the voluntary sector response to AIDS: a comparative study of the UK and Germany

The impact of AIDS on Western polities serves as a useful indicator both of social values and of political and organisational relationships. At the same time, community-based nonprofit organisations have been at the forefront of AIDS policy-making and service development. Taking Britain and Germany as case studies, this paper discusses similarities and differences in the functions accorded to the voluntary sector in the pattern of responses to HIV and AIDS. Typical problems confronted by emergent voluntary sector welfare agencies are noted and particular features of AIDS service organisations described. Separate accounts are then given of the development of a federated network of AIDS service organisations (ASOs) in Germany and of contrasting experience in the UK. While governments have shared a concern to confine the activity of ASOs to serving the needs of those groups directly affected by AIDS, other significant differences in policy development may be attributed to differences in the organisational structure of the health sector.

Publication Type: journal paper      Source: Voluntas 3 (1) 29-47
Date: 1992       Link: