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Good models borrow, great models steal: intellectual property rights and generative AI 好模型借用,大模型偷窃:知识产权与生成式人工智能
IF 9.3 1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2024-02-12 DOI: 10.1093/polsoc/puae006
Simon Chesterman
Two critical policy questions will determine the impact of generative artificial intelligence (AI) on the knowledge economy and the creative sector. The first concerns how we think about the training of such models—in particular, whether the creators or owners of the data that are “scraped” (lawfully or unlawfully, with or without permission) should be compensated for that use. The second question revolves around the ownership of the output generated by AI, which is continually improving in quality and scale. These topics fall in the realm of intellectual property, a legal framework designed to incentivize and reward only human creativity and innovation. For some years, however, Britain has maintained a distinct category for “computer-generated” outputs; on the input issue, the EU and Singapore have recently introduced exceptions allowing for text and data mining or computational data analysis of existing works. This article explores the broader implications of these policy choices, weighing the advantages of reducing the cost of content creation and the value of expertise against the potential risk to various careers and sectors of the economy, which might be rendered unsustainable. Lessons may be found in the music industry, which also went through a period of unrestrained piracy in the early digital era, epitomized by the rise and fall of the file-sharing service Napster. Similar litigation and legislation may help navigate the present uncertainty, along with an emerging market for “legitimate” models that respect the copyright of humans and are clear about the provenance of their own creations.
两个关键的政策问题将决定生成式人工智能(AI)对知识经济和创意产业的影响。第一个问题涉及我们如何看待此类模型的训练问题,特别是被 "搜刮"(合法或非法、经许可或未经许可)的数据的创建者或所有者是否应就这种使用获得补偿。第二个问题是人工智能所产生的产出的所有权问题,人工智能的质量和规模都在不断提高。这些问题都属于知识产权的范畴,而知识产权是一个法律框架,旨在激励和奖励人类的创造力和创新。不过,多年来,英国一直为 "计算机生成 "的产出保留了一个独特的类别;在输入问题上,欧盟和新加坡最近推出了例外条款,允许对现有作品进行文本和数据挖掘或计算数据分析。本文探讨了这些政策选择的广泛影响,权衡了降低内容创作成本和专业技术价值的优势与各种职业和经济部门可能面临的潜在风险,因为后者可能导致无法持续发展。音乐产业也经历过早期数字时代无节制盗版的时期,文件共享服务 Napster 的兴衰就是一个缩影。类似的诉讼和立法可能有助于应对当前的不确定性,以及尊重人类版权、明确自身创作来源的 "合法 "模式的新兴市场。
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引用次数: 0
Actors, alterations, and authorities: three observations of global policy and its transnational administration 行为者、变化和权威:对全球政策及其跨国管理的三点观察
IF 9.3 1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2024-02-01 DOI: 10.1093/polsoc/puae003
Kim Moloney, Tim Legrand
This Special Issue and its seven contributions seek to shift the gaze of public policy scholarship toward the authorities, legitimacies, and influences of transnational actors on the creation and implementation of global policy and its transnational administration. It is, in large part, both a demonstration of the analytical and explanatory value of accounting for the influence of non-state actors on global issues as well as a normative reflection on what this means for already tenuous connections between publics and those that make decisions on their behalf in global forums. This Issue breaks with heterodox public policy approaches that center on the capabilities of states and international organizations to determine and to deliver global public policy and outcomes. Instead, we widen our gaze to capture the influence of transnational actors such as global commissions, transnational public–private partnerships, philanthropic foundations, non-government organization networks, domestic associations with global influence, quasi-judicial authorities, and global citizen activists. The articles discuss the impact of transnational actors on the policy and administrative spaces of global actors and states alike. By dispensing with the notion that the state and state-created international organizations are the primary locus for public policy and public administration scholarship, the included papers conclude with the implications for scholarship on transnational actor authorities and legitimacies.
本特刊及其七篇论文力图将公共政策学术研究的视角转向跨国行动者的权威、合法性以及对全球政策的制定和实施及其跨国管理的影响。在很大程度上,这既是对非国家行为者对全球问题的影响的分析和解释价值的展示,也是对公众与那些在全球论坛上代表公众做出决策的人之间本已脆弱的联系的规范性反思。本期杂志打破了以国家和国际组织决定和执行全球公共政策和结果的能力为中心的非正统公共政策方法。相反,我们扩大了视野,以捕捉跨国行动者的影响力,如全球委员会、跨国公私合作伙伴关系、慈善基金会、非政府组织网络、具有全球影响力的国内协会、准司法当局和全球公民活动家。这些文章讨论了跨国行动者对全球行动者和国家的政策和行政空间的影响。通过摒弃国家和国家创建的国际组织是公共政策和公共行政学术研究的主要阵地这一观念,这些论文最后提出了对跨国行动者权威与合法性学术研究的影响。
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引用次数: 0
Policy dissidents: Understanding girl activism as creating “Tactical Crevices” 持不同政见者:将女孩行动主义理解为创造 "战术缝隙"
IF 9.3 1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2024-02-01 DOI: 10.1093/polsoc/puae001
Shenila Khoja-Moolji, Mary Ann Chacko
Global policymaking often seeks to create processes for the effective delivery of public goods and services. What happens when individuals critique or dissent such policies? In this paper, we examine the case of two activists—Greta Thunberg and Disha Ravi—who have been mobilizing attention toward climate change since their teenage years, and who have been both celebrated and vilified for it. While climate change policies emphasize the importance of gender mainstreaming and youth participation, reactions garnered by these two activists are instructive in highlighting the narrow notion of “participation” that ungirds climate policy. Specifically, we show that Greta and Disha’s tactics do not readily jive with the postfeminist, neoliberal conceptualization of youth participation that emphasizes apolitical exercise of citizenship; valorizes girls’ activism only insofar as it enhances national economic growth; and views girls as symbols of hopeful futurities. Greta and Disha are instead what we call, “policy dissidents,” whose activism creates “tactical crevices.” We theorize tactical crevices as tentative and fleeting interruptions by the powerless that puncture prevailing logics through strikes and protests, and through consumption of discourses and materials in ways that those in power do not intend. The paper contributes to the study of girl activism broadly, and to notions of youth engagement (or disengagement) specifically, within the spheres of local and global politics.
全球政策制定通常寻求建立有效提供公共产品和服务的程序。当个人对这些政策提出批评或异议时,会发生什么呢?在本文中,我们将研究两位活动家--格丽塔-图恩伯格(Greta Thunberg)和迪莎-拉维(Disha Ravi)--的案例,她们从十几岁起就开始动员人们关注气候变化,并因此受到赞誉和诽谤。虽然气候变化政策强调性别主流化和青年参与的重要性,但这两位活动家所引起的反响却具有启发性,凸显了 "参与 "这一狭隘概念对气候政策的影响。具体而言,我们表明,格丽塔和迪莎的策略与后女权主义、新自由主义的青年参与概念并不一致,后女权主义、新自由主义的青年参与概念强调非政治性地行使公民权,只在促进国家经济增长时才重视女孩的积极性,并将女孩视为充满希望的未来的象征。格丽塔和迪莎则是我们所说的 "政策持不同政见者",她们的行动主义创造了 "战术缝隙"。我们将 "战术缝隙 "理论化,认为它是无权者通过罢工和抗议活动,以及通过以掌权者无意的方式消费话语和材料,对主流逻辑进行的试探性和稍纵即逝的打断。本文对广义上的女孩行动主义研究,以及具体到地方和全球政治领域的青年参与(或脱离)概念都有所贡献。
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引用次数: 0
The rising authority and agency of public–private partnerships in global health governance 公私伙伴关系在全球卫生治理中的权威和作用日益增强
IF 9.3 1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2024-01-21 DOI: 10.1093/polsoc/puad032
Antoine de Bengy Puyvallée
Global public–private partnerships (PPPs) have become prominent in efforts to address global challenges, particularly in the health field. In the scholarly literature, global PPPs have been conceptualized as arenas for voluntary public–private cooperation rather than agents of global governance. This paper challenges this approach, arguing that a sub-class of highly institutionalized partnerships have developed into transnational bureaucracies that, much like international organizations, can draw from their administrative capacities to exercise agency and gain and consolidate authority over time. To substantiate this argument, I present an in-depth analysis of five global health partnerships that played a leading role in the Access to Covid-19 Tools Accelerator (ACT-A), the initiative that sought to coordinate the global response to covid-19. Based on extensive document review and analysis of the ACT-A PPPs —Gavi, the Vaccine Alliance, The Global Fund to Fight AIDS, Tuberculosis and Malaria, The Coalition for Epidemic Preparedness Innovation, Unitaid, and The Foundation for Innovative New Diagnostics — I show how these partnerships’ leadership role during the pandemic emerged from a decade long build-up of PPP agency. These organizations gained administrative capacities that enabled them to increase their authority vis-à-vis their donors, boards, and other external actors through three interlinked strategies: (a) developing greater financial autonomy; (b) expanding their mandates (including toward pandemic preparedness and response); and (c) establishing inter-partnership cooperation and mutual representation to other forums. My analysis suggests the need for future research to consider highly institutionalized PPPs as agents of global governance and to explore empirically and theoretically the consequences of their rising authority.
全球公私伙伴关系(PPPs)在应对全球挑战的努力中已变得十分突出,尤其是在卫生领域。在学术文献中,全球公私合作伙伴关系被概念化为自愿性公私合作的舞台,而不是全球治理的媒介。本文对这一观点提出质疑,认为高度制度化的伙伴关系中的一个子类已经发展成为跨国官僚机构,与国际组织一样,可以利用其行政能力行使代理权,并随着时间的推移获得和巩固权威。为了证实这一论点,我深入分析了在 "获取 Covid-19 工具加速器"(ACT-A)中发挥主导作用的五个全球卫生伙伴关系,该倡议旨在协调全球应对 Covid-19 的行动。基于对 ACT-A 伙伴关系--Gavi、疫苗联盟、全球抗击艾滋病、结核病和疟疾基金、流行病防备创新联盟、Unitaid 和创新诊断基金会--的大量文件审查和分析,我展示了这些伙伴关系在大流行期间的领导作用是如何从长达十年的伙伴关系机构建设中产生的。这些组织获得了行政管理能力,使其能够通过以下三个相互关联的战略,提高其在捐助者、董事会和其他外部行为者面前的权威:(a) 发展更大的财务自主权;(b) 扩大其任务范围(包括大流行病的准备和应对);(c) 建立伙伴关系之间的合作和在其他论坛的相互代表。我的分析表明,今后的研究需要将高度制度化的公私伙伴关系视为全球治理的推动者,并从经验和理论上探讨其权威上升的后果。
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引用次数: 1
Policy sequencing can increase public support for ambitious climate policy 政策排序可增加公众对雄心勃勃的气候政策的支持
IF 9.3 1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2023-12-07 DOI: 10.1093/polsoc/puad030
Simon Montfort, Lukas Fesenfeld, Isabelle Stadelmann-Steffen, Karin Ingold
Public support for ambitious climate policies and carbon prices that have direct costs for voters may depend on policy sequencing. Policy sequencing theory suggests that the strategic ordering of policies into sequences that initially create benefits can subsequently increase support for higher carbon prices. However, systematic quantitative evidence about the effects of sequencing on public support is lacking. We provide novel theoretical and empirical insights on the mechanisms through which strategic policy sequencing affects public support for climate policies. We generated these insights using geospatial data and a representative conjoint experiment with Swiss voters conducted just before the popular vote on an amendment to the Federal Act on the Reduction of Greenhouse Gas Emissions in June 2021. Our evidence shows that the perceived effectiveness of prior policy-induced benefits is related to more public support for higher carbon prices across sectors. Moreover, we find that more opportunity structures for low-emission alternatives—like higher EV charging station density—are associated with increased public support for carbon prices in the sector where the former material benefits occur. Our results also imply that positive policy perceptions of prior climate policies are related to increased support, particularly among conservative voters and those who do not regard climate change as a salient issue. Thus, strategic policy sequencing could be an effective strategy for broadening public support for ambitious climate policies.
公众对雄心勃勃的气候政策和对选民有直接成本的碳价格的支持可能取决于政策排序。政策排序理论认为,战略性地将政策排序为最初能带来利益的序列,可随后增加对更高碳价格的支持。然而,关于排序对公众支持的影响,目前还缺乏系统的定量证据。我们就战略性政策排序影响公众对气候政策支持的机制提供了新的理论和经验见解。我们利用地理空间数据,并在 2021 年 6 月对《减少温室气体排放联邦法案》修正案进行民众投票之前,对瑞士选民进行了一次具有代表性的联合实验,从而得出了这些见解。我们的证据表明,先前政策所带来的利益的可感知有效性与各行业公众对更高碳价格的更多支持有关。此外,我们还发现,低排放替代品的更多机会结构--如更高的电动汽车充电站密度--与公众对碳价格的更多支持相关,而碳价格正是前者带来的实质性好处。我们的研究结果还表明,对先前气候政策的积极政策认知与支持率的提高有关,特别是在保守派选民和那些不把气候变化视为突出问题的选民中。因此,战略性的政策排序可能是扩大公众对雄心勃勃的气候政策支持的有效策略。
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引用次数: 0
Blame avoidance and credit-claiming dynamics in government policy communications: evidence from leadership tweets in four OECD countries during the 2020–2022 COVID-19 pandemic 政府政策沟通中的责任回避和信用索取动态:来自2020-2022年COVID-19大流行期间四个经合组织国家领导人推文的证据
IF 9.3 1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2023-11-28 DOI: 10.1093/polsoc/puad029
Ching Leong, Michael Howlett, Mehrdad Safaei
Government information activities are often thought to be motivated by a classic calculus of blame minimization and credit maximization. However, the precise interactions of “blame” and “credit” communication activities in government are not well understood, and questions abound about how they are deployed in practice. This paper uses Natural Language Processing (NLP) machine-learning sentiment analysis of a unique dataset composed of several thousand tweets of high-level political leaders in four OECD countries—namely the Prime Ministers of the United Kingdom, Ireland, Australia, and Canada—during 2020–2022 to examine the relationships existing between “blame” and “credit” communication strategies and their relation to the changing severity of the COVID-19 pandemic, both in an objective and subjective sense. In general, the study suggests that during this high-impact, long-lasting, and waxing and waning crisis, political leaders acted in accordance with theoretical expectations when it came to communicating credit seeking messages during the periods when the COVID situation was thought to be improving, but they did not exclusively rely upon communicating blame or scapegoating when the situation was considered to be deteriorating. The consequences of this finding for blame and credit-based theories of government communication are then discussed.
政府的信息活动通常被认为是由一个经典的责任最小化和信用最大化的计算所驱动的。然而,政府中“指责”和“信任”传播活动的确切相互作用尚未得到很好的理解,关于如何在实践中部署它们的问题比比皆是。本文使用自然语言处理(NLP)机器学习对一个独特的数据集进行情感分析,该数据集由四个经合组织国家(即英国、爱尔兰、澳大利亚和加拿大的总理)的数千条推文组成,在2020-2022年期间,从客观和主观的角度审视“指责”和“信任”沟通策略之间存在的关系,以及它们与COVID-19大流行严重程度变化的关系。总的来说,研究表明,在这场影响巨大、持续时间长、时断时续的危机中,政治领导人在传播寻求信贷的信息时,在人们认为新冠疫情正在好转的时期,按照理论预期行事,但在人们认为疫情正在恶化的时期,他们并不完全依赖于传播指责或找替罪羊。然后讨论了这一发现对指责和基于信用的政府沟通理论的影响。
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引用次数: 0
Is there a behavioral revolution in policy design? A new agenda and inventory of the behavioral toolbox 在政策设计中是否存在一场行为革命?一个新的议程和行为工具箱的清单
1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2023-11-06 DOI: 10.1093/polsoc/puad028
Anders Esmark
Abstract The article argues for a revised research on behavioral public policy focused on the core claim and sine qua non of a behavioral “revolution”: the ability to produce equal or better outcomes with less stringent policy designs than in traditional solutions, at least for certain types of problems. Three contributions to such an agenda are proposed. First, the article argues that the growing focus on the evaluation of real-world behavioral policy programs, as opposed to experimental studies within specialized areas of research, calls for a corresponding theoretical orientation toward existing literature on policy tools and design. Second, a doctrine of policy design is extrapolated from the broader behavioral paradigm and specified in relation to four general areas of application. These provide an essential context for the evaluation of the behavioral claim to improved policy design and highlight that behavioral successes may well, contra this claim, be a result of a de facto increase in stringency vis-à-vis traditional responses. Third, the article proposes a new and substantially revised inventory of the behavioral toolbox, which specifies the stringency, mechanisms, and potential costs of different behavioral tools and techniques, which is both essential to the evaluation of the behavioral claim and necessary to overcome the arbitrariness and mistakes of existing inventories.
本文主张对行为公共政策进行修订研究,重点关注行为“革命”的核心主张和必要条件:至少对于某些类型的问题,用不那么严格的政策设计产生与传统解决方案相同或更好的结果的能力。对这一议程提出了三点建议。首先,本文认为,与专业研究领域的实验研究相反,越来越多的人关注对现实世界行为政策项目的评估,这要求对现有的政策工具和设计文献进行相应的理论导向。其次,政策设计的原则是从更广泛的行为范式中推断出来的,并具体说明了四个一般应用领域。这些为评价改进政策设计的行为主张提供了一个基本背景,并强调,与这一主张相反,行为上的成功很可能是相对-à-vis传统反应事实上增加严格程度的结果。第三,本文提出了一个新的、经过实质性修订的行为工具箱清单,其中详细说明了不同行为工具和技术的严格性、机制和潜在成本,这既是评估行为主张所必需的,也是克服现有清单的随意性和错误所必需的。
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引用次数: 0
The role of policy design in policy continuation and ratcheting-up of policy ambition 政策设计在政策延续和政策野心提升中的作用
1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2023-09-14 DOI: 10.1093/polsoc/puad027
Sebastian Sewerin, Lukas P Fesenfeld, Tobias S Schmidt
Abstract Effectively addressing grand societal challenges like climate change and environmental degradation requires policy intervention that is not only continuous but also increasing in ambition over time. However, negative feedback could lead to policies being weakened or even discontinued after a while. An important but unresolved policy question, therefore, is whether policies can be deliberately designed to survive (i.e., to “stick”) and, ideally, be replaced with more ambitious ones over time (i.e., to “ratchet up”). We bridge policy feedback and policy design scholarship to derive hypotheses on the effects of two policy design features—“intensity” (i.e., a measure of policies’ overall design) and “specificity” (i.e., a measure of policies’ targeted focus)—on policy (dis-)continuation and ratcheting-up (-down) of ambition. Focusing on policy design, we contribute to the theorization and empirical understanding of endogenous factors behind policy change. We test our hypotheses with an event history dataset of 627 low-carbon energy policies in eight developed countries. Conducting a multilevel survival analysis, we find statistically significant evidence of more intense policies being replaced with less intense ones, i.e., more intense policies lead to ratcheting-down of ambition. We also find that more specific policies are more likely to be replaced with more intense policies, i.e., more specific policies lead to ratcheting-up of ambition. Based on these novel insights, we discuss how policy design can navigate these complex dynamics. In this sense, our approach also contributes to the discussion about the “forward-looking” potential of the policy sciences.
有效应对气候变化和环境退化等重大社会挑战需要持续的政策干预,而且随着时间的推移,政策干预的力度也会越来越大。然而,负面反馈可能导致政策被削弱,甚至在一段时间后停止。因此,一个重要但尚未解决的政策问题是,政策是否可以被刻意设计成能够持续(即“坚持”),并且在理想情况下,随着时间的推移,被更雄心勃勃的政策(即“逐步”)所取代。我们将政策反馈和政策设计学术联系起来,得出关于两个政策设计特征——“强度”(即政策总体设计的衡量标准)和“特异性”(即政策目标重点的衡量标准)对政策(非)延续和雄心(下降)的影响的假设。我们以政策设计为重点,对政策变化背后的内生因素进行了理论化和实证理解。我们用8个发达国家627项低碳能源政策的事件历史数据集来检验我们的假设。通过进行多层次生存分析,我们发现了统计上显著的证据,表明力度更大的政策被力度较小的政策所取代,也就是说,力度更大的政策会导致野心的降低。我们还发现,更具体的政策更有可能被更激烈的政策所取代,也就是说,更具体的政策会导致野心的增强。基于这些新颖的见解,我们讨论了政策设计如何驾驭这些复杂的动态。从这个意义上说,我们的方法也有助于讨论政策科学的“前瞻性”潜力。
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引用次数: 0
“State captured” policy advice? Think tanks as expert advisors in the Western Balkans “国家占领”的政策建议?作为西巴尔干地区专家顾问的智库
IF 9.3 1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2023-09-07 DOI: 10.1093/polsoc/puad021
Irena Djordjevic, Diane Stone
Few scholars have dedicated their attention to the role of think tanks as policy experts within captured states. We investigate how, why, and to what extent think tanks are used in the captured states in the Western Balkans. Our assumption was that think tanks could become party to the processes of “capture”. However, original findings from focus group and interviews with think tankers show that think tank expertise is perceived as an imposed obligation—from external pressures and existing national regulatory frameworks. Accordingly, incorporation of think tank policy advice is fulfilled to an extent, but not necessarily for the sake of improving the quality of public policies. In this environment, think tanks are enrolled in the simulacra of inclusive policy deliberation without substantially influencing policy making. Nevertheless, these organizations have developed creative mechanisms to survive, preserve their independence, and still foster advice uptake within captured bureaucracies. Openly value-driven advice is the overarching one.
很少有学者关注智库作为被占领国家的政策专家所扮演的角色。我们调查了西巴尔干被占国家如何、为什么以及在多大程度上使用智库。我们的假设是,智库可以成为“捕获”过程的一方。然而,焦点小组和智库访谈的原始发现表明,由于外部压力和现有的国家监管框架,智库专业知识被视为一种强加的义务。因此,虽然在一定程度上实现了智囊团政策建议的纳入,但并不一定是为了提高公共政策的质量。在这种环境下,智库被纳入包容性政策审议的模拟,而不会对政策制定产生实质性影响。然而,这些组织已经发展出创造性的机制来生存,保持它们的独立性,并且仍然在被控制的官僚机构中促进建议的吸收。公开的价值导向的建议是最重要的。
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引用次数: 0
Knowledge–practice gap in healthcare payments: the role of policy capacity 医疗保健支付中的知识与实践差距:政策能力的作用
1区 社会学 Q1 POLITICAL SCIENCE Pub Date : 2023-09-01 DOI: 10.1093/polsoc/puad019
Azad Singh Bali, M Ramesh
Abstract Fee-for-service remains a popular mode of paying for healthcare despite widespread knowledge of its ill effects. This has resulted in a gap between policy knowledge (understood as consensus among experts) and policy practice (actual policy measures to implement the consensus) in healthcare. The existing literature attributes such gaps to a range of factors, including the stakeholders’ different interests, incentives, ideas, and values. Our focus on this debate is through the lens of policy capacity, specifically the ability of public actors to utilize policy knowledge and inform policy practice. We show that the observed knowledge–practice gap is rooted in the complexity of healthcare payment reforms. While actors agree on the problematic condition, there is a deep disagreement on what to do about it. Agreeing on and adopting alternate payment arrangements are challenging because reformers need to anticipate and respond to the future while accommodating the interests of the current providers who benefit from the status quo. In such instances, the capacity of public actors to devise reforms and overcome resistance to them is critical. We argue that the knowledge–practice gap in healthcare payments exists because of deficiencies in the analytical abilities of governments to devise workable alternate arrangements and shortcomings in their political capacity to overcome the resistance to proposed reforms. Put differently, we argue that no amount of evidence or consensus among stakeholders is sufficient when the analytical and political capacities to act on the evidence are lacking. The arguments are illustrated with reference to payment reforms in South Korea and Thailand.
服务收费仍然是一种流行的医疗保健支付模式,尽管人们普遍知道它的不良影响。这导致了医疗保健领域政策知识(理解为专家之间的共识)和政策实践(执行共识的实际政策措施)之间的差距。现有文献将这种差距归因于一系列因素,包括利益相关者不同的利益、激励、想法和价值观。我们关注的焦点是政策能力,特别是公共行为体利用政策知识并为政策实践提供信息的能力。我们表明,观察到的知识与实践差距是植根于医疗支付改革的复杂性。虽然演员们对这个有问题的条件达成了一致,但在如何处理这个问题上却存在着深刻的分歧。就替代支付安排达成一致并采用是具有挑战性的,因为改革者需要预测和应对未来,同时照顾目前受益于现状的提供者的利益。在这种情况下,公共行为者设计改革和克服对改革的阻力的能力至关重要。我们认为,医疗保健支付方面的知识与实践差距的存在,是因为政府在设计可行的替代安排的分析能力方面存在缺陷,以及他们在克服对拟议改革的阻力方面的政治能力存在缺陷。换句话说,我们认为,当缺乏根据证据采取行动的分析和政治能力时,任何证据或利益相关者之间的共识都是不够的。这些论点以韩国和泰国的支付改革为例加以说明。
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