CHP Lecture Summary
Inhoudsopgave
Week 1:......................................................................................................................................................... 1
Lecture 1: Introduction Three Puzzles...................................................................................................................1
Lecture 2. Methods of comparative health policy analysis..................................................................................3
Week 2: Comparative Health Policy................................................................................................................ 5
Lecture 3 : Institutional theory.............................................................................................................................5
Week 3........................................................................................................................................................ 15
Lecture 4: institutional Work..............................................................................................................................15
Week 4:....................................................................................................................................................... 18
Lecture 5: Policy Convergence............................................................................................................................18
Week 1:
Lecture 1: Introduction Three Puzzles
Puzzle 1: why are HC policies different (or similar) across national contexts?
Puzzle 2: why is health policy reform so difficult to undertake?
Puzzle 3: what are conditions for successful policy learning?
Health policy: What is it?
- There have been different definition but we focus on a narrow definition:
- Often: a narrow government perspective
- A focus on one institutional arrangement: the state
- So definition: those courses of action proposed or taken by governments that affect the
health of their populations (blank, burau,2014)
What is health policy?
- In this course we take a broader governance perspective.
- A focus on various institutional arrangements including the market and civil
society/associations.
- ‘course of action (and inaction) that affects the set of institutions, organizations, services and
funding arrangements of the health system. Includes policy made in the public sector (by
government) as well as policies in the private sector. (…) health policy analysist are also
interested in the actions and intended actions of organizations external to the health system
which have an impact on health (for example the food, tobacco or pharmaceutical industries,
(Buse et al. 2005).
Comparative research: What can comparison teach us?
- Allows us to get a better idea about the range of variation that exists and also helps to avoid
both false particularism (everywhere is special: so saying that every country is unique and
you cannot compare them) and false universalism (everywhere is the same: every country is
the same and we see broadly similar solutions, that is not the case when you take a closer
look) (blank and burau 2014).
- By comparing you can see what is specific for a country and what is more generalizable.
1
, - Three purposes of comparative health policy analysis:
1. Learning about : characteristics of the two countries.
2. Leanring why : why there are differences and similarities?
3. Learning from : under what conditions do countries learn from each other.
What research is done (and what is still missing?)
Beckfield et al 2013: four central debates in comparative (social science) literature on healthcare
systems: see literature summary
1. System typologies 2. Convergence 3. Institutional boundaries 4. Inequalities in access and
outcome
- Five missed sociological turns:
1. The relational turn 2. The cultural turn 3. The postnational turn 4. The institutional turn.
5. The mechanismic turn.
Institutional theory
Using institutional theory as a tool to solve policy puzzles
- Theory gives you focus (in finding a topic, in formulating your research question, collecting
data, in interpreting your findings, in drawing conclusions).
- Institutional theory is a collection of different perspectives and concepts with newer articles
filling the gaps (or problematizing) earlier work.
Institutional orders (1980s).
- We often still use this theory but
it was developed earlier.
- This is a model from an article:
just an example. Not mandatory.
- They distinguish between
different institutional orders:
community, market state and
associations.
Similar model: institutional orders still used today:
- Institutional arrangements. Now
in this article they combine the
model with gradual change
theory. Next slide this is explained.
Further development of the field of institutional theory
- 1990s three new institutionalisms. key authors: Hall and Taylor see literature summary
o Main issue: they saw different explanations for policy continuity.
1. Historical institutionalism
2. Sociological institutionalism
3. Rational choice institutionalism
o Focus on policy continuity is what they have in common.
2
, In historical you also use path dependency: once you have chosen a certain
path it is difficult to change and future decisions are influenced by path
decisions. When you do see change they argue it is an abrupt change, e.g.
due to a sudden shock
o Critique: gradual institutional change was developed
- 2000s Gradual institutional change. Key authors: Mohoney and Thelen: see literature
summary
o As a critique on the three new institutionalisms the gradual institutional change
theory is developed.
o Apart from those sudden changes and abrupt external shocks, we more often see
More focus on gradual change happening from within the system. Endogenous
instead of exogenous. Although these changes look small in itself, they can build op
to transformation of institutions and health policy.
- 2010s: institutional work. Key authors: Lawrance and Suddaby see literature summary
o Argue that all the earlier theories have a certain focus on the macro level and
changes that happen, but the role of actors is not clear within those changes.
o They developed the institutional work concept and focus on collective and individual
actors and how they change maintain or disrupt certain institutions.
o Not only focusing on influential people within the field, so policy makers or
politicians. But also different types of actors: professionals for example.
Lecture 2. Methods of comparative health policy analysis
How can we find out which of the factors play a role?
Example: migrant live-in care workers normal in some countries, exceptional in others
Explanations: cultural diversity: individualistic vs collectivistic
- In some countries people are used to multiple generations living in the same house
- The HC system: LTC system: Is LTC a public or private responsibility
- Specific Regulations: can personal budgets be used to pay for these type of services
How can we find out which factors play a role and how they are interrelated?
Different types of comparative methods can be used to find this out.
Della Porta: 2 options for comparative policy research see literature summary
1. Variable oriented approach
2. Case oriented approach,
Variable oriented research Case-oriented research
What? You compare many countries and Differs from the variable oriented research
translate these countries into a design
collection of variables
Number of cases Large N Small N (2/3 countries)
Country studies as Combination of variables Holistic entities (want to do justice to the
details in their policies
Use of theory More deductive (testing hypothesis More inductive (like qualitative research)
Type of question Which factors lead to a certain How can we understand that country A&B
outcome? are similar(different) in many ways, but
differ(similar) in HC policy X?
How can we understand that country C and
D are different in many ways, but are similar
3
Inhoudsopgave
Week 1:......................................................................................................................................................... 1
Lecture 1: Introduction Three Puzzles...................................................................................................................1
Lecture 2. Methods of comparative health policy analysis..................................................................................3
Week 2: Comparative Health Policy................................................................................................................ 5
Lecture 3 : Institutional theory.............................................................................................................................5
Week 3........................................................................................................................................................ 15
Lecture 4: institutional Work..............................................................................................................................15
Week 4:....................................................................................................................................................... 18
Lecture 5: Policy Convergence............................................................................................................................18
Week 1:
Lecture 1: Introduction Three Puzzles
Puzzle 1: why are HC policies different (or similar) across national contexts?
Puzzle 2: why is health policy reform so difficult to undertake?
Puzzle 3: what are conditions for successful policy learning?
Health policy: What is it?
- There have been different definition but we focus on a narrow definition:
- Often: a narrow government perspective
- A focus on one institutional arrangement: the state
- So definition: those courses of action proposed or taken by governments that affect the
health of their populations (blank, burau,2014)
What is health policy?
- In this course we take a broader governance perspective.
- A focus on various institutional arrangements including the market and civil
society/associations.
- ‘course of action (and inaction) that affects the set of institutions, organizations, services and
funding arrangements of the health system. Includes policy made in the public sector (by
government) as well as policies in the private sector. (…) health policy analysist are also
interested in the actions and intended actions of organizations external to the health system
which have an impact on health (for example the food, tobacco or pharmaceutical industries,
(Buse et al. 2005).
Comparative research: What can comparison teach us?
- Allows us to get a better idea about the range of variation that exists and also helps to avoid
both false particularism (everywhere is special: so saying that every country is unique and
you cannot compare them) and false universalism (everywhere is the same: every country is
the same and we see broadly similar solutions, that is not the case when you take a closer
look) (blank and burau 2014).
- By comparing you can see what is specific for a country and what is more generalizable.
1
, - Three purposes of comparative health policy analysis:
1. Learning about : characteristics of the two countries.
2. Leanring why : why there are differences and similarities?
3. Learning from : under what conditions do countries learn from each other.
What research is done (and what is still missing?)
Beckfield et al 2013: four central debates in comparative (social science) literature on healthcare
systems: see literature summary
1. System typologies 2. Convergence 3. Institutional boundaries 4. Inequalities in access and
outcome
- Five missed sociological turns:
1. The relational turn 2. The cultural turn 3. The postnational turn 4. The institutional turn.
5. The mechanismic turn.
Institutional theory
Using institutional theory as a tool to solve policy puzzles
- Theory gives you focus (in finding a topic, in formulating your research question, collecting
data, in interpreting your findings, in drawing conclusions).
- Institutional theory is a collection of different perspectives and concepts with newer articles
filling the gaps (or problematizing) earlier work.
Institutional orders (1980s).
- We often still use this theory but
it was developed earlier.
- This is a model from an article:
just an example. Not mandatory.
- They distinguish between
different institutional orders:
community, market state and
associations.
Similar model: institutional orders still used today:
- Institutional arrangements. Now
in this article they combine the
model with gradual change
theory. Next slide this is explained.
Further development of the field of institutional theory
- 1990s three new institutionalisms. key authors: Hall and Taylor see literature summary
o Main issue: they saw different explanations for policy continuity.
1. Historical institutionalism
2. Sociological institutionalism
3. Rational choice institutionalism
o Focus on policy continuity is what they have in common.
2
, In historical you also use path dependency: once you have chosen a certain
path it is difficult to change and future decisions are influenced by path
decisions. When you do see change they argue it is an abrupt change, e.g.
due to a sudden shock
o Critique: gradual institutional change was developed
- 2000s Gradual institutional change. Key authors: Mohoney and Thelen: see literature
summary
o As a critique on the three new institutionalisms the gradual institutional change
theory is developed.
o Apart from those sudden changes and abrupt external shocks, we more often see
More focus on gradual change happening from within the system. Endogenous
instead of exogenous. Although these changes look small in itself, they can build op
to transformation of institutions and health policy.
- 2010s: institutional work. Key authors: Lawrance and Suddaby see literature summary
o Argue that all the earlier theories have a certain focus on the macro level and
changes that happen, but the role of actors is not clear within those changes.
o They developed the institutional work concept and focus on collective and individual
actors and how they change maintain or disrupt certain institutions.
o Not only focusing on influential people within the field, so policy makers or
politicians. But also different types of actors: professionals for example.
Lecture 2. Methods of comparative health policy analysis
How can we find out which of the factors play a role?
Example: migrant live-in care workers normal in some countries, exceptional in others
Explanations: cultural diversity: individualistic vs collectivistic
- In some countries people are used to multiple generations living in the same house
- The HC system: LTC system: Is LTC a public or private responsibility
- Specific Regulations: can personal budgets be used to pay for these type of services
How can we find out which factors play a role and how they are interrelated?
Different types of comparative methods can be used to find this out.
Della Porta: 2 options for comparative policy research see literature summary
1. Variable oriented approach
2. Case oriented approach,
Variable oriented research Case-oriented research
What? You compare many countries and Differs from the variable oriented research
translate these countries into a design
collection of variables
Number of cases Large N Small N (2/3 countries)
Country studies as Combination of variables Holistic entities (want to do justice to the
details in their policies
Use of theory More deductive (testing hypothesis More inductive (like qualitative research)
Type of question Which factors lead to a certain How can we understand that country A&B
outcome? are similar(different) in many ways, but
differ(similar) in HC policy X?
How can we understand that country C and
D are different in many ways, but are similar
3
