Do parties and institutions still matter for healthcare? Multi-dimensional partisanship, veto points, and the legislative politics of healthcare

Whereas classical welfare state literature viewed party politics and institutional veto points as central to health politics, contemporary literature has cast doubt on this claim. We contribute to this debate by testing whether parties and veto institutions matter for healthcare, drawing on a dataset of health reforms introduced by 719 laws across 33 European countries from 1990 to 2019. Our findings show that political partisanship and veto institutions do remain central for health politics. However, their impact varies by the dimension of partisanship and the health policy sub-issue. While economic left-right partisanship of governments predicts privatisation laws, social left-right partisanship predicts laws that introduce patient rights. Veto points hinder the enactment of privatisation legislation; they do not impede the enactment of patient rights legislation. Based on these findings, we draw three theoretical implications. First, government legislative behaviour reflects partisan priorities in healthcare, constituting a key mechanism of party competition. Second, legislative competition on health is structured along multiple partisan dimensions, positional and valence forms, and is defined through health policy sub-issues. Third, institutional veto points constrain legislative outcomes, but their impact is conditional on the partisan context.