Path Dependency and the Politics of Socialized Health Care

Abstract

Rich democracies exhibit vast cross-national and historical variation in the socialization of health care. Yet, cross-national analyses remain relatively rare in the health policy literature and health care remains relatively neglected in the welfare state literature. We analyze pooled time series models of the public share of total health spending for eighteen rich democracies from 1960 to 2010. Building on path dependency theory, we present a strategy for modeling the relationship between the initial 1960 public share and the current public share. We also examine two contrasting accounts for how the 1960 public share interacts with conventional welfare state predictors: the self-reinforcing hypothesis expecting positive feedbacks and the counteracting hypothesis expecting negative feedbacks. We demonstrate that most of the variation from 1960 to 2010 in the public share can be explained by a country's initial value in 1960. This 1960 value has a large significant effect in models of 1961-2010, and including the 1960 value alters the coefficients of conventional welfare state predictors. To investigate the mechanism whereby prior social policy influences public opinion about current social policy, we use the 2006 International Social Survey Programme (ISSP). This analysis confirms that the 1960 values predict individual preferences for government spending on health. Returning to the pooled time series, we demonstrate that the 1960 values interact significantly with several conventional welfare state predictors. Some interactions support the self-reinforcing hypothesis, while others support the counteracting hypothesis. Ultimately, this study illustrates how historical legacies of social policy exert substantial influence on the subsequent politics of social policy.

Changing the ward culture in a clinic during the implementation of person-centred care

“…[1,2] This has also proven to be the case in public health-care organizations. [3] Professional territorialism and organizational inertia have been identified as reasons for slow routines and path dependency.…”

The political economy of health financing reforms in Zimbabwe: a scoping review

“…Notably, whilst in some developed countries health financing reform is through a legislative process which provides multiple ‘veto points’ [ 15 , 16 ], this was not clear cut in Zimbabwe. Therefore, whilst policy change in these contexts is inherently slow and incremental due to the effect of path dependency [ 17 , 18 , 78 ], the role of the legislative process was not clearly visible in Zimbabwe. This suggests that informal institutions might carry considerable weight for health reform processes in countries such as Zimbabwe.…”

“…Countries with institutional designs that incorporate a greater number of “veto points”— where the consent of certain individuals or bodies is required to pass legislation— will experience more difficulties in passing health reform options [ 10 , 15 , 16 ]. A key feature of institutions is path dependency, which in most general form, simply claims that the past has a powerful effect on the present which creates a historical policy legacy [ 17 ]. These historical legacies “lock” countries into certain trajectories and exert inertia on current politics even after a long time lag and act as potent focusing devices that constrain future policy changes from the status quo.…”

The rules of the game: Healthcare systems and cross-national attitudes about healthcare provision

“…Consistent with prior studies, we include the respondent's age, age squared, educational attainment, employment status, gender, and income (e.g. Brady et al, 2016;Kikuzawa et al, 2008). Vulnerable groups, such as older people, women, and the unemployed, who may benefit from welfare policies are more likely to support greater government involvement in healthcare (Kikuzawa et al, 2008).…”