Assessing health reform: studying tool appropriateness & critical capacities

Abstract

The past two decades have witnessed unprecedented policy effort to improve access to medical services and strengthen financial protection from catastrophic healthcare expenditure. Despite billions of dollars in health spending, manyespecially across the developing worldcontinue to remain vulnerable to financial impoverishment. What accounts for this poor performance? To respond to this question, we turn to the design literature in public policy, which emphasises the role of policy tools or combination of tools in addressing a social problem. In this paper, we focus on two interrelated aspects of the design orientation to explain outcomes: a) the appropriateness of the policy tool and b) the capacity of government agencies. We apply a framework, which integrates vital questions on both these aspects along three common dimensions (analytical, operational and political) to assess healthcare reforms in India and Thailand. The case studies illustrate the importance of both these aspects of the design orientation in explaining outcomes, and show how they are commonly overlooked in the health and social policy literatures, and in reforms underway.

The Political Economic Sources of Policy Non-design, Policy Accumulation, and Decay in Policy Capacity

“…Yet policy design scholarship also needs to examine how (non-)design impact bureaucratic behavior: given the critical role bureaucracy plays both in the design process and implementation, as this study demonstrates that (prolonged) non-design may cause decay in policy capacity but, perhaps more importantly, generate policy alienation among bureaucrats. Fifth, and finally, matching instruments with capacities is crucial (Bali & Ramesh, 2019); however, such an endeavor may not come about in a non-design space, as this space is characterized by the lack of will or forces that could mobilize even existing capacities. In this regard, public policy scholarship can aim to tease out the mechanisms and conditions of non-design generating decay in policy capacity in different forms and at varying levels.…”

Policy Capacity Within the Local Anticorruption Political Agenda (A Study of Corruption Prevention in the Post-Covid-19 Economic Recovery Program in Malang City)

“…It is most evident in the form of trust levels, particularly political trust and legitimacy in the public sector. Political, individual, and organizational capacities are also needed to gain support from key stakeholders, both before and during the design process, as well as in the upcoming policy implementation phase [28]. The effectiveness of instruments and how they are assessed hinges on three factors.…”

Stefnugeta í íslenska stjórnkerfinu

“…2017;Karo & Kattel 2018;Daugbjerg o.fl. 2018;Bali & Ramesh 2019). Þrátt fyrir að hún hafi að mestu leyti verið skoðuð út frá sjónarhorni ríkisins, er fyrirbaerið mun víðtaekara og naer einnig til hagsmunahópa og atvinnulífsins.…”