From local networks to national reform? Programmatic groups in the regionalization of German health policy

Before policy reform initiatives reach the agenda of national decision makers, such initiatives often start at a small-scale, local level. The Programmatic Action Framework (PAF) emphasizes the importance of biographical connections to understand how a group of policy actors forms, and how it develops programs that may lead to decade-long policy change. This article applies the PAF to study the emergence of a programmatic group behind initiatives on regionalization in German health policy through discourse analysis and expert interviews. The study contributes to understanding social networks behind policy programs and social-psychological, partly informal drivers of policy change. The results show that many PAF conditions have already been met in the German health policy subsystem. We describe a network of policy actors with local and organizational drivers that has led to nationwide cooperation on regionalization.