Haenni Emmenegger, MalenaMalenaHaenni Emmenegger2023-04-132023-04-132021-09-20https://www.alexandria.unisg.ch/handle/20.500.14171/109915Lately, federalism research has come to focus increasingly on the horizontal cooperation be-tween substates. So far, the academic community has been mostly concerned with intergovern-mental agreements and arrangements and thereby neglecting the multifaceted nature of such co-operation, namely its important informal aspects such as information exchange and everyday collaboration at the administrative level. To address this lacuna, I have developed a three-level cooperation concept to cover the whole phenomenon. This study uses a multi-method approach to examine how different influencing factors affect the cooperation relationships between two cantons and how they vary depending on the cooperation level. The empirical field under study is the acute stationary care, of which Swiss cantons are responsible for planning and provision and in which national politicians and health experts long have called for increased cooperation and larger health regions. The study consists of two analytical sections, for which I have undertaken a comprehensive data collection on the cantonal cooperation activities from 2009 to 2018, following the introduction of the legal obligation to coordinate cantonal hospital planning. Based on this data I have developed a cooperation index measuring the intensity of cooperation relations between the 325 pairs of Swiss cantons. As a statistical method I use valued Exponential Random Graph Mod-els, an application of social network analysis. I proceed to explore how horizontal cooperation can succeed in a politically salient field by an intertemporal comparison of two related cases using causal process tracing in the second section. Aiming to establish a causal chain of events I rely on historical-institutionalist concepts such as path dependency and the blame avoid-ance/credit claiming framework. The statistical analysis shows that population size of cantons and the difference in popula-tion size between the cooperation partners play out differently depending on the level of cooperation. The results of the case study further show that a combination of two complementary partners, increased external problem pressure and a convincing framing of cooperation as an opportunity finally brought about the intended cooperation. Towards this purpose, decisionmakers skillfully used the whole range of strategies such as blame avoidance, phasing-in and retrenchment as credit claiming. The failed predecessor project suggests that the context factors size difference of the partners and external problem pressure were decisive for these strategies to have the intended impact.deGesundheitspolitikFöderalismusSchweizInterkantonale KooperationEDIS-5108hospital planninghospitalsHorizontal cooperationHorizontale KooperationLUNISSpitalplanungKrankenversicherungsgesetzSpitälerhealth insurance actdoctoral thesis