Cost-Oriented Healthcare Policies From A Political Legitimacy Perspective: A Conceptual Discussion
Cost-Oriented Healthcare Policies From A Political Legitimacy Perspective: A Conceptual Discussion

Summary/Abstract: This study analyzes the structural tension between the pursuit of efficiency and the need for democratic legitimacy in contemporary health policies. Since the neoliberal reforms of the 1980s, health services have been restructured under the logic of New Public Management and market-oriented governance, emphasizing performance, cost-effectiveness, and measurable outputs. However, such reforms have not only reduced health policies to a purely technical domain but also undermined the core components of democratic legitimacy. The study adopts a conceptual analysis approach, drawing on Weber’s concept of legal-rational authority, Beetham’s three-dimensional model of legitimacy, and Habermas’s theory of communicative action to evaluate the political implications of cost-based reforms. The findings reveal that decisions justified solely by cost analyses and performance indicators reduce citizen participation to a symbolic level, complicate accountability chains, and produce a narrow understanding of legitimacy based solely on “output success.” In conclusion, the structural conflict between cost-efficiency and democratic legitimacy poses a critical risk to the sustainability of health policies. The study emphasizes the need for new governance models that maintain cost-effectiveness while deepening citizen participation, strengthening accountability, and grounding legitimacy not only in performance but also in normative values.

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