Health Care Policy for Better or for Worse? Examining NHS Reforms During Times of Economic Crisis versus Relative Stability

Abstract

Economic crises are said to challenge welfare states by forcing them to cut expenditure by pursuing reforms aimed at cost containment and efficiency enhancing strategies. The oil crises of the 1970s and early 1980s, the global financial crisis of the early 1990s, and those of the 2000s marked acute economic phases rooted within a larger period of austerity politics in which welfare states have been observed to undergo major changes. However, the question has yet to be posed as to whether decisions affecting health care policy during acute economic crises are indeed fundamentally different than what can normally be observed over the longer period of cost containment policy. Moreover, where policy differences do exist between economic periods, are these differences consistent over time and across health care systems? To answer these questions we examine changes in regulation over the past four decades for two cases of National Health Services (NHS): England and Italy. More specifically, we examine the underlying causes for reforms in order to identify whether economic crises versus 'system-specific deficits' (i.e. those deficits or sources for inefficiency lodged within the health care system itself) are the true causes for motivating change in and across NHS systems. Our findings establish that while acute economic crises create windows of opportunity for change, it is the interaction of system-specific deficits and the role of ideas and political factors that largely condition the content and timing of reforms. Regarding the nature of reforms passed, our findings reveal consistency over time and across health care systems in the types of regulatory measures adopted and advanced.s pol_786 488..505

Redefining the State in Health Care Policy in Italy and the United States

“…This concept is based on the functionalist notion which holds that health care systems, in an effort to correct for system‐specific deficits, adopt features from other system types to compensate for their own failings, thereby leading to regulatory hybridization. The authors also argue (in line with Schmid et al., and Frisina Doetter & Götze, ) that this functionalist drive to correct for system deficits may be triggered by exogenous stressors to the system (e.g., demographic change, economic shocks) which may also be modified by the role of intervening variables rooted within the political–institutional landscape.…”

“…Austerity policies adopted after the financial crisis intensified earlier trends to transform the NHS into a more hybrid system characterized by public retrenchment, and a growing role for privatization and corporatization in health care financing (see e.g., Frisina Doetter & Götze, ; Neri, Pavolini & Vicarelli, ; Pavolini & Vicarelli, ). It is not possible to say whether this result was deliberately pursued by some policy‐makers, who might have used the financial and sovereign debt crisis as an opportunity to indirectly promote a higher level of privatization within the system, or whether this was an unintended though predictable consequence of austerity.…”

Portuguese healthcare reforms in the context of crisis: External pressure or domestic choice?

“…However, other literature on policy change in the context of crisis suggests the view of external factors as key determinants of change might not explain the variety of changes taking place or account for the domestic factors that continue to play a crucial role in policy transformation (e.g., Frisina‐Doetter & Götze, ; Pavolini & Guillén, ). Even in economically harsh times, when countries are vulnerable and face external pressure to reform, domestic realities, such as country and policy‐specific institutional and political context, can have a substantial influence on the scope, nature, and direction of policy change.…”

“…Although the specific characteristics of the political dynamics will vary across countries, the literature on the politics of welfare reforms in the context of crisis suggests some cross‐country patterns. One is the tendency of political elites to use a crisis as window of opportunity for reform, which can be particularly useful in healthcare, a sector characterized by pressure to introduce reforms that are both sensitive and unpopular (Frisina‐Doetter & Götze, ; Pavolini & Guillén, ; Roubal, ). A related strategy is blame avoidance, wherein political elites avoid responsibility for unpopular reforms by blaming others for them (Bonoli & Natali, ; Weaver, ).…”

Searching for a nursing job in an increased complexity of the labour market: An integrative review of the literature

“…The majority of them were conducted before the economic crisis affecting the Western world. [34] Studies have described the phenomenon mainly for women thus reflecting a possible gender bias in the findings, [26] although most nurses are female. The retrieved studies involved mainly newly graduated nurses, with a wide age range, from young new graduates (18 years [30] ) to mature (from 26 to 30 [28] ), up to 65, [29] thus reflecting different job expectations and job searching capabilities.…”