Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1659126
Susan P Sparkes, Joseph Kutzin, Alexandra J Earle
Abstract Collective financing, in the form of either public domestic revenues or pooled donor funding, at the country level is necessary to finance common goods for health, which are population-based functions or interventions that contribute to health and have the characteristics of public goods. Financing of common goods for health is an important part of policy efforts to move towards Universal Health Coverage (UHC). This paper builds from country experiences and budget documents to provide an evidence-based argument about how government and donor financing can be reorganized to enable more efficient delivery of common goods for health. Issues related to fragmentation of financing—within the health sector, across sectors, and across levels of government—emerge as key constraints. Effectively addressing fragmentation issues requires: (i) pooling funding and consolidating governance structures to repackage functions across programs; (ii) aligning budgets with efficient delivery strategies to enable intersectoral approaches and related accountability structures; and (iii) coordinating and incentivizing investments across levels of government. This policy response is both technical in nature and also highly political as it requires realigning budgets and organizational structures.
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Pub Date : 2019-10-02DOI: 10.1080/23288604.2019.1648736
O. Gómez-Dantés, J. Frenk
CONTENTS Conceptual Framework of the Mexican Health Reform Financial Architecture of the System for Social Protection inHealth Health-Related Common Goods of the SSPH References A series of studies developed in Mexico in the late 1990s identified disturbing rates of catastrophic health expenditures as a result of the fact that approximately half of the Mexican population, 50 million people, lacked health insurance. This analysis exposed a dreadful paradox: we know that health contributes to the reduction of poverty, yet medical care can itself produce financial stress when a country lacks the social instruments to assure fair financing of personal healthcare services. In 2003, the government of President Vicente Fox secured support from all political parties for legislation aimed at correcting that paradox. A reform to the National Health Law created the System for Social Protection in Health (SSPH). The most prominent component of SSPH is Seguro Popular (SP), a health insurance scheme funded predominantly through federal and state subsidies. Following congressional approval of SP, the government began implementation of the new system in January of 2004. Public expenditure was gradually expanded to finance healthcare coverage for non-salaried workers and their families, who had been excluded from conventional, employment-based social insurance. The mobilization of additional financial resources for health was made possible by the increase of oil prices between 1999 and 2008, a situation that benefited Mexico, an oil-exporter country. This allowed for a major increase of social expenditure. By 2018, over 53 million people were enrolled in the new scheme and had access to a comprehensive package of essential services and a package of high-cost interventions. The country was on track to achieving the goal of universal coverage. A lot has been written about SP, its financial innovations, and its impacts on healthcare coverage, health conditions, and financial protection. However, little is published about the other components of SSPH, more specifically, its common goods components. The purpose of this article is to describe and discuss the common goods for health elements
内容:墨西哥卫生改革概念框架社会保障体系与健康相关的共同利益参考文献20世纪90年代末在墨西哥开展的一系列研究确定了令人不安的灾难性卫生支出率，这是由于大约一半的墨西哥人口(5000万人)缺乏医疗保险。这一分析揭示了一个可怕的悖论:我们知道健康有助于减少贫困，但当一个国家缺乏确保个人医疗保健服务公平融资的社会工具时，医疗保健本身就会产生财政压力。2003年，总统比森特·福克斯(Vicente Fox)领导的政府获得了所有政党的支持，通过了旨在纠正这一悖论的立法。对《国家卫生法》的改革建立了健康社会保护制度。SSPH最突出的组成部分是Seguro Popular (SP)，这是一项主要由联邦和州补贴资助的健康保险计划。国会批准SP后，政府于2004年1月开始实施新制度。公共支出逐步扩大，用于资助被排除在传统的、以就业为基础的社会保险之外的非受薪工人及其家庭的医疗保险。1999年至2008年期间，石油价格上涨，使墨西哥这个石油出口国受益，从而为卫生事业调动了额外的财政资源。这使得社会开支有了很大的增加。到2018年，超过5300万人参加了新计划，并获得了全面的一揽子基本服务和一揽子高成本干预措施。该国正在实现全民覆盖的目标。关于SP、其金融创新及其对医疗保健覆盖范围、健康状况和财务保护的影响，已经有很多文章。然而，关于SSPH的其他成分，更具体地说，它的普通商品成分，很少发表。本文的目的是描述和讨论健康要素的共同商品
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Pub Date : 2019-09-30DOI: 10.1080/23288604.2019.1617026
Faraz Khalid, Maria Petro Brunal, A. Sattar, S. Laokri, M. Jowett, Wajeeha Raza, D. Hotchkiss
ABSTRACT The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011–12 and the Pakistan Social Living and Measurement Survey 2012–13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores. The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients’ satisfaction were found to be correlated with efficiency scores. This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC.
{"title":"Assessing the Efficiency of Sub-National Units in Making Progress Towards Universal Health Coverage: Evidence from Pakistan","authors":"Faraz Khalid, Maria Petro Brunal, A. Sattar, S. Laokri, M. Jowett, Wajeeha Raza, D. Hotchkiss","doi":"10.1080/23288604.2019.1617026","DOIUrl":"https://doi.org/10.1080/23288604.2019.1617026","url":null,"abstract":"ABSTRACT The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011–12 and the Pakistan Social Living and Measurement Survey 2012–13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores. The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients’ satisfaction were found to be correlated with efficiency scores. This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"106 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80435151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1633894
J. Shiffman
The articles in this special issue make two particularly valuable contributions to understanding health financing reform. First, through historical case studies, they provide rich empirical evidence showing that reform is more than a technical matter: it is also a heavily political undertaking. Second, they provide guidance to reformers on political management, illustrating the utility of a framework that identifies groups of actors who facilitate and obstruct change, including interest groups and political leaders. A focus on political management highlights the role of human agency in health financing reform. Reform is shaped not only by agency but also by political context—enduring political and social arrangements not easily altered by the actions of individuals. For instance, the adoption and smooth implementation of reform may be more likely in a country with a government that has a unitary political structure that limits the ability of anti-reform groups to block change. Several scholars warn against excessive analytical focus on the actions of individuals, as doing so may mask the role of structural forces and long-term social processes in explaining political and social outcomes, including social welfare policy adoption and implementation. The articles in this special issue attend to political context but highlight individual agency. In this commentary, I do the reverse. I do so with a view to calling attention to some of the larger and more enduring factors—pertaining to nature of the political system and party rule, features of civil society, and the global political environment—that alongside human agency may explain why major health financing reforms advance in some national settings but not others.
{"title":"Political Context and Health Financing Reform","authors":"J. Shiffman","doi":"10.1080/23288604.2019.1633894","DOIUrl":"https://doi.org/10.1080/23288604.2019.1633894","url":null,"abstract":"The articles in this special issue make two particularly valuable contributions to understanding health financing reform. First, through historical case studies, they provide rich empirical evidence showing that reform is more than a technical matter: it is also a heavily political undertaking. Second, they provide guidance to reformers on political management, illustrating the utility of a framework that identifies groups of actors who facilitate and obstruct change, including interest groups and political leaders. A focus on political management highlights the role of human agency in health financing reform. Reform is shaped not only by agency but also by political context—enduring political and social arrangements not easily altered by the actions of individuals. For instance, the adoption and smooth implementation of reform may be more likely in a country with a government that has a unitary political structure that limits the ability of anti-reform groups to block change. Several scholars warn against excessive analytical focus on the actions of individuals, as doing so may mask the role of structural forces and long-term social processes in explaining political and social outcomes, including social welfare policy adoption and implementation. The articles in this special issue attend to political context but highlight individual agency. In this commentary, I do the reverse. I do so with a view to calling attention to some of the larger and more enduring factors—pertaining to nature of the political system and party rule, features of civil society, and the global political environment—that alongside human agency may explain why major health financing reforms advance in some national settings but not others.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"19 1","pages":"257 - 259"},"PeriodicalIF":4.1,"publicationDate":"2019-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87926031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1630595
V. Tangcharoensathien, W. Patcharanarumol, Anond Kulthanmanusorn, N. Saengruang, Hathairat Kosiyaporn
Abstract Thailand achieved full population coverage of financial protection for health care in 2002 with successful implementation of the Universal Coverage Scheme (UCS). The three public health insurance schemes covered 98.5% of the population by 2015. Current evidence shows a high level of service coverage and financial risk protection and low level of unmet healthcare need, but the path toward UHC was not straightforward. Applying the Political Economy of UHC Reform Framework and the concept of path dependency, this study reviews how these factors influenced the evolution of the UHC reform in Thailand. We highlight how path dependency both set the groundwork for future insurance expansion and contributed to the persistence of a fragmented insurance pool even as the reform team was able to overcome certain path inefficient institutions and adopt more evidence-based payment schemes in the UCS. We then highlight two critical political economy challenges that can hamper reform, if not managed well, regarding the budgeting processes, which minimized the discretionary power previously exerted by Bureau of Budget, and the purchaser–provider split that created long-term tensions between the Ministry of Public Health and the National Health Security Office. Though resisted, these two changes were key to generating adequate resources to, and good governance of, the UCS. We conclude that although path dependence played a significant role in exerting pressure to resist change, the reform team’s capacity to generate and effectively utilize evidence to guide policy decision-making process enabled the reform to be placed on a “good path” that overcame opposition.
{"title":"The Political Economy of UHC Reform in Thailand: Lessons for Low- and Middle-Income Countries","authors":"V. Tangcharoensathien, W. Patcharanarumol, Anond Kulthanmanusorn, N. Saengruang, Hathairat Kosiyaporn","doi":"10.1080/23288604.2019.1630595","DOIUrl":"https://doi.org/10.1080/23288604.2019.1630595","url":null,"abstract":"Abstract Thailand achieved full population coverage of financial protection for health care in 2002 with successful implementation of the Universal Coverage Scheme (UCS). The three public health insurance schemes covered 98.5% of the population by 2015. Current evidence shows a high level of service coverage and financial risk protection and low level of unmet healthcare need, but the path toward UHC was not straightforward. Applying the Political Economy of UHC Reform Framework and the concept of path dependency, this study reviews how these factors influenced the evolution of the UHC reform in Thailand. We highlight how path dependency both set the groundwork for future insurance expansion and contributed to the persistence of a fragmented insurance pool even as the reform team was able to overcome certain path inefficient institutions and adopt more evidence-based payment schemes in the UCS. We then highlight two critical political economy challenges that can hamper reform, if not managed well, regarding the budgeting processes, which minimized the discretionary power previously exerted by Bureau of Budget, and the purchaser–provider split that created long-term tensions between the Ministry of Public Health and the National Health Security Office. Though resisted, these two changes were key to generating adequate resources to, and good governance of, the UCS. We conclude that although path dependence played a significant role in exerting pressure to resist change, the reform team’s capacity to generate and effectively utilize evidence to guide policy decision-making process enabled the reform to be placed on a “good path” that overcame opposition.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"13 1","pages":"195 - 208"},"PeriodicalIF":4.1,"publicationDate":"2019-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89601689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1625251
P. Campos, M. Reich
ABSTRACT Any effort to improve health system performance must address the challenges of policy implementation. This article examines one aspect of implementation—the politics of policy implementation for the health sector, particularly the management of stakeholders in order to help change teams improve the chances of achieving policy objectives. Based on a literature scan of political analyses and descriptions of health policy implementation in low- and middle-income countries, we propose six major categories of stakeholder groups that are likely to influence implementation: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. The categories of stakeholders can be overlapping. We examine the politics of these different stakeholder categories, and then present selected examples of published case studies that show the types of implementation challenges that arise for each category and how implementers can use political strategies to manage specific stakeholder groups and related political processes. Understanding the political dimensions of implementation can help those responsible for implementation drive policy into practice more effectively. Understanding and addressing conflict, resistance and cooperation among stakeholders are key to managing the implementation process. Systematic and continuous political analysis can help decision makers and change teams improve the chances for successful implementation.
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Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1649915
Susan P Sparkes, Joseph Kutzin, A. Soucat, J. Bump, M. Reich
CONTENTS References This special issue of Health Systems & Reform, sponsored by the World Health Organization (WHO), places political economy at the center of health financing reform. The motivation for the World Health Organization’s program of work in this area is to make political economy analysis an integral part of reform design, adoption, and implementation processes to improve the performance and equity of health systems. The articles show the importance of political economy factors in influencing the outcomes of health financing reform. They also highlight how political economy analysis can be a powerful lever to improve the chances that technically sound policy proposals are adopted and implemented. This special issue provides guidance to reformers—those who lead health policy development and implementation—on how to use political economy analysis to advance health financing reform in support of Universal Health Coverage. The authors in this project have first-hand experience with health reform in a variety of ministerial, multilateral, and academic positions. The articles focus on how reform teams can maneuver within their own national contexts to navigate complex political economy dynamics in ways that enable reform. Each example stresses that good ideas and evidence alone often do not produce desired results. Reformers need political skills to convert reform plans into implemented policy. Although the impetus for health financing reform can come from different sources, often policymakers and government must lead the charge for change. Typically, this is the case with health financing reform, which inherently has redistributive implications, between beneficiary groups, rich and poor, healthy and sick, young and old, and powerful and powerless. As highlighted in the World Development Report 2004, the push for policy change can come directly from citizens collectively organized to demand altered benefits (i.e., “people”). In the health sector, citizens can sometimes influence “providers,” but generally they cannot affect
{"title":"Introduction to Special Issue on Political Economy of Health Financing Reform","authors":"Susan P Sparkes, Joseph Kutzin, A. Soucat, J. Bump, M. Reich","doi":"10.1080/23288604.2019.1649915","DOIUrl":"https://doi.org/10.1080/23288604.2019.1649915","url":null,"abstract":"CONTENTS References This special issue of Health Systems & Reform, sponsored by the World Health Organization (WHO), places political economy at the center of health financing reform. The motivation for the World Health Organization’s program of work in this area is to make political economy analysis an integral part of reform design, adoption, and implementation processes to improve the performance and equity of health systems. The articles show the importance of political economy factors in influencing the outcomes of health financing reform. They also highlight how political economy analysis can be a powerful lever to improve the chances that technically sound policy proposals are adopted and implemented. This special issue provides guidance to reformers—those who lead health policy development and implementation—on how to use political economy analysis to advance health financing reform in support of Universal Health Coverage. The authors in this project have first-hand experience with health reform in a variety of ministerial, multilateral, and academic positions. The articles focus on how reform teams can maneuver within their own national contexts to navigate complex political economy dynamics in ways that enable reform. Each example stresses that good ideas and evidence alone often do not produce desired results. Reformers need political skills to convert reform plans into implemented policy. Although the impetus for health financing reform can come from different sources, often policymakers and government must lead the charge for change. Typically, this is the case with health financing reform, which inherently has redistributive implications, between beneficiary groups, rich and poor, healthy and sick, young and old, and powerful and powerless. As highlighted in the World Development Report 2004, the push for policy change can come directly from citizens collectively organized to demand altered benefits (i.e., “people”). In the health sector, citizens can sometimes influence “providers,” but generally they cannot affect","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"43 1","pages":"179 - 182"},"PeriodicalIF":4.1,"publicationDate":"2019-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86958710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1634382
L. Gilson
In the mid-1990s Michael Reich and Gill Walt, drawing on independent lines of work, called for an injection of political economy thinking into health policy analysis in lowand middle-income countries (LMICs). Reich noted that “policy reform is inevitably political because it seeks to change who gets valued goods in society” and Walt, that health policy is “concerned with who influences whom in the making of policy, and how that happens. Both concluded that neither primarily technicalwork, such as economic analysis, nor awelldesigned policy are themselves enough to bring about policy change. Rather, deliberate and specific analysis of the wider political forces, the actors, processes and power, influencing such change is necessary to understand its political feasibility —and to consider how to support the process of change. As we approach 2020, the call for Universal Health Coverage (UHC) has ensured that health financing reform is on policy agendas around the world. Such large-scale health financing and system reform is quintessentially political—given that interests compete, there is much to gain and lose, and the current institutional status quo is inevitably challenged. It is no surprise that health financing reform is being contested and debated in parliaments as well as publicly from the highest to lowest income countries. Yet, there remains barely any political economy analysis of health financing reform in LMICs. Although there is no current mapping of literature in the field, only 13 out of 100 exemplar papers included in the 2018 LMIC Health Policy Analysis Reader had an explicit focus on financing policy. Earlier mapping reviews have demonstrated the small and fragmented nature of the overall field, and its limited consideration of health financing issues. In an overall field review for 1994–2007, only 15 out of 164 empirical papers addressed such issues and over
{"title":"Reflections from South Africa on the Value and Application of a Political Economy Lens for Health Financing Reform","authors":"L. Gilson","doi":"10.1080/23288604.2019.1634382","DOIUrl":"https://doi.org/10.1080/23288604.2019.1634382","url":null,"abstract":"In the mid-1990s Michael Reich and Gill Walt, drawing on independent lines of work, called for an injection of political economy thinking into health policy analysis in lowand middle-income countries (LMICs). Reich noted that “policy reform is inevitably political because it seeks to change who gets valued goods in society” and Walt, that health policy is “concerned with who influences whom in the making of policy, and how that happens. Both concluded that neither primarily technicalwork, such as economic analysis, nor awelldesigned policy are themselves enough to bring about policy change. Rather, deliberate and specific analysis of the wider political forces, the actors, processes and power, influencing such change is necessary to understand its political feasibility —and to consider how to support the process of change. As we approach 2020, the call for Universal Health Coverage (UHC) has ensured that health financing reform is on policy agendas around the world. Such large-scale health financing and system reform is quintessentially political—given that interests compete, there is much to gain and lose, and the current institutional status quo is inevitably challenged. It is no surprise that health financing reform is being contested and debated in parliaments as well as publicly from the highest to lowest income countries. Yet, there remains barely any political economy analysis of health financing reform in LMICs. Although there is no current mapping of literature in the field, only 13 out of 100 exemplar papers included in the 2018 LMIC Health Policy Analysis Reader had an explicit focus on financing policy. Earlier mapping reviews have demonstrated the small and fragmented nature of the overall field, and its limited consideration of health financing issues. In an overall field review for 1994–2007, only 15 out of 164 empirical papers addressed such issues and over","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"11 1","pages":"236 - 243"},"PeriodicalIF":4.1,"publicationDate":"2019-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87833442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1633874
Susan P Sparkes, J. Bump, Ece A Özçelik, Joseph Kutzin, M. Reich
Abstract Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. As a result, changes in health financing policy affect a range of stakeholders and institutions in ways that can create political obstacles and tensions. As countries pursue health financing policies that support progress towards Universal Health Coverage, the analysis and management of these political concerns must be incorporated in reform processes. This article proposes an approach to political economy analysis to help policy makers develop more effective strategies for managing political challenges that arise in reform. Political economy analysis is used to assess the power and position of key political actors, as a way to develop strategies to change the political feasibility of desired reforms. Applying this approach to recent health financing reforms in Turkey and Mexico shows the importance of political economy factors in determining policy trajectories. In both cases, reform policies are analyzed according to the roles and positions of major categories of influential stakeholders: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. The strategic responses to each political economy factor stress the connectedness of technical and political processes. Applying the approach to the two cases of Turkey and Mexico retrospectively shows its relevance for understanding reform experiences and its potential for helping decision makers manage reform processes prospectively. Moving forward, explicit political economy analysis can become an integral component of health financing reform processes to inform strategic responses and policy sequencing.
{"title":"Political Economy Analysis for Health Financing Reform","authors":"Susan P Sparkes, J. Bump, Ece A Özçelik, Joseph Kutzin, M. Reich","doi":"10.1080/23288604.2019.1633874","DOIUrl":"https://doi.org/10.1080/23288604.2019.1633874","url":null,"abstract":"Abstract Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. As a result, changes in health financing policy affect a range of stakeholders and institutions in ways that can create political obstacles and tensions. As countries pursue health financing policies that support progress towards Universal Health Coverage, the analysis and management of these political concerns must be incorporated in reform processes. This article proposes an approach to political economy analysis to help policy makers develop more effective strategies for managing political challenges that arise in reform. Political economy analysis is used to assess the power and position of key political actors, as a way to develop strategies to change the political feasibility of desired reforms. Applying this approach to recent health financing reforms in Turkey and Mexico shows the importance of political economy factors in determining policy trajectories. In both cases, reform policies are analyzed according to the roles and positions of major categories of influential stakeholders: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. The strategic responses to each political economy factor stress the connectedness of technical and political processes. Applying the approach to the two cases of Turkey and Mexico retrospectively shows its relevance for understanding reform experiences and its potential for helping decision makers manage reform processes prospectively. Moving forward, explicit political economy analysis can become an integral component of health financing reform processes to inform strategic responses and policy sequencing.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"52 1","pages":"183 - 194"},"PeriodicalIF":4.1,"publicationDate":"2019-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88876785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-03DOI: 10.1080/23288604.2019.1635414
Ashley M. Fox, Yongjin Choi
Abstract The US remains the only high-income country that lacks a universal health financing system and instead relies on a fragmented system with the largest segment of the population receiving health insurance through private, voluntary employer-sponsored health insurance plans. While not “universal” in the sense of being mandatory and tax-financed, through a series of reforms, the US has managed to provide some form of health insurance coverage to 90% of the population. Yet, the high cost of this system, the insufficient coverage afforded to many, and continued concerns about equity have led to calls for a national health insurance program that can reduce costs across the board while providing high-quality coverage for all. Given the policy gridlock at the national level, the states have often sought to achieve universal health financing on their own, but these bills have met with little success so far. Why has the ideal of states as “laboratories of democracy” failed to produce policy change towards national health insurance? This article examines the prospects for the New York Health Act, a single-payer bill that would create a universal health financing plan for all New York State residents. Applying the Political Economy of Health Financing Framework, we analyze the politics of health reform in New York State and identify strategies to overcome opposition to this policy proposal. We find that while a clear political opportunity is in place, the prospects for adoption remain low given the power of symbolic politics and institutional inertia on the reform process.
{"title":"Political Economy of Reform under US Federalism: Adopting Single-Payer Health Coverage in New York State","authors":"Ashley M. Fox, Yongjin Choi","doi":"10.1080/23288604.2019.1635414","DOIUrl":"https://doi.org/10.1080/23288604.2019.1635414","url":null,"abstract":"Abstract The US remains the only high-income country that lacks a universal health financing system and instead relies on a fragmented system with the largest segment of the population receiving health insurance through private, voluntary employer-sponsored health insurance plans. While not “universal” in the sense of being mandatory and tax-financed, through a series of reforms, the US has managed to provide some form of health insurance coverage to 90% of the population. Yet, the high cost of this system, the insufficient coverage afforded to many, and continued concerns about equity have led to calls for a national health insurance program that can reduce costs across the board while providing high-quality coverage for all. Given the policy gridlock at the national level, the states have often sought to achieve universal health financing on their own, but these bills have met with little success so far. Why has the ideal of states as “laboratories of democracy” failed to produce policy change towards national health insurance? This article examines the prospects for the New York Health Act, a single-payer bill that would create a universal health financing plan for all New York State residents. Applying the Political Economy of Health Financing Framework, we analyze the politics of health reform in New York State and identify strategies to overcome opposition to this policy proposal. We find that while a clear political opportunity is in place, the prospects for adoption remain low given the power of symbolic politics and institutional inertia on the reform process.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"87 1","pages":"209 - 223"},"PeriodicalIF":4.1,"publicationDate":"2019-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88469245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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