Market Reforms in Europe: Market Reforms in Europe: Dynamics of Policy Fashion Dynamics of Policy Fashion Michael I. Harrison* Michael I. Harrison* Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Presented at Academy Health Annual Research Meeting Presented at Academy Health Annual Research Meeting June 6, 2004, San Diego. June 6, 2004, San Diego. *Email: [email protected]*Email: [email protected]
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Market Reforms in Europe: Dynamics of Policy Fashion Michael I. Harrison* Agency for Healthcare Research and Quality Presented at Academy Health Annual.
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Market Reforms in Europe: Dynamics Market Reforms in Europe: Dynamics of Policy Fashionof Policy Fashion
Michael I. Harrison*Michael I. Harrison*Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality
Presented at Academy Health Annual Research MeetingPresented at Academy Health Annual Research MeetingJune 6, 2004, San Diego. June 6, 2004, San Diego.
EXPLAINING DYNAMICS EXPLAINING DYNAMICS OF POLICY FASHIONOF POLICY FASHION
Observations: Observations:
– Policy makers in Britain, Sweden, and the Netherlands adopted Policy makers in Britain, Sweden, and the Netherlands adopted market reform policies quickly and uncritically. market reform policies quickly and uncritically.
– Decision makers and their constituencies soon became disenchanted Decision makers and their constituencies soon became disenchanted with market reforms, once the proposed changes proved hard to with market reforms, once the proposed changes proved hard to implement. implement.
– The health policy agenda shifted quickly, as policy makers explored The health policy agenda shifted quickly, as policy makers explored new options.new options.
Research question: Did the rapid rise and decline of political Research question: Did the rapid rise and decline of political support for market reforms in health care reflect the support for market reforms in health care reflect the dynamics of policy fashion? dynamics of policy fashion?
POLICY FASHION DEFINEDPOLICY FASHION DEFINED
The rapid rise and decline in political support for a set of The rapid rise and decline in political support for a set of policy-related beliefs, principles, programs, or techniques is policy-related beliefs, principles, programs, or techniques is called policy fashion when these shifts reflect the dynamics called policy fashion when these shifts reflect the dynamics and interactions of fashion setting, policy formation and and interactions of fashion setting, policy formation and adoption, and policy implementation.adoption, and policy implementation.
DYNAMICS OF POLICY FASHIONS
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Fashion Setting
Support for Policy Trend
Demand For Policy Fashions
Policy Formation
and
Adoption
Policy Implementation
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FASHION SETTINGFASHION SETTING
Fashion setters --policy gurus, universities, consultants, media Fashion setters --policy gurus, universities, consultants, media -- actively promote new policies.-- actively promote new policies.
Setters define favorite new policies as progressive and Setters define favorite new policies as progressive and rational.rational.
Initial discourse is enthusiastic and uncritical.Initial discourse is enthusiastic and uncritical.
FORMATION AND ADOPTION FORMATION AND ADOPTION OF POLICY FASHIONOF POLICY FASHION
Advocates in governments and agencies urge adoption of Advocates in governments and agencies urge adoption of policies promoted by high-status setters and used by high-policies promoted by high-status setters and used by high-status organizations and sectors. status organizations and sectors.
Policy makers alter fashions from other sectors to fit target Policy makers alter fashions from other sectors to fit target sector.sector.
FORCES CREATING DEMAND FOR FORCES CREATING DEMAND FOR POLICY FASHIONSPOLICY FASHIONS
Norms of progress and rationalityNorms of progress and rationality
Budgeting processes and career ladders in public agenciesBudgeting processes and career ladders in public agencies
Economic cyclesEconomic cycles
Organizational and technical contradictions (e.g., public Organizational and technical contradictions (e.g., public accountability vs. professional autonomy; disease intervention accountability vs. professional autonomy; disease intervention vs. wellness)vs. wellness)
FORCES AFFECTING SUPPORT FOR FORCES AFFECTING SUPPORT FOR POLICY TRENDSPOLICY TRENDS
Trends in political beliefs and valuesTrends in political beliefs and values Social and cultural changeSocial and cultural change Electoral politicsElectoral politics Interactions among policy actorsInteractions among policy actors Organizational and technical conditionsOrganizational and technical conditions Policy precedents and institutional commitmentsPolicy precedents and institutional commitments
FORCES UNDERMINING SUPPORT FOR FORCES UNDERMINING SUPPORT FOR IMPLEMENTED POLICY IMPLEMENTED POLICY
Implementation complications and strugglesImplementation complications and struggles Disappointment with resultsDisappointment with results
Outcomes of policy fashions Outcomes of policy fashions alwaysalways fall below original expectations (and stated objectives) and fall below original expectations (and stated objectives) and costs costs alwaysalways exceed estimates, exceed estimates, because initial expectations were unrealistic and overly optimisticbecause initial expectations were unrealistic and overly optimistic. .
Changes in forces affecting demand for policy trend.Changes in forces affecting demand for policy trend. Competition from other policies, including new policy fashions.Competition from other policies, including new policy fashions.
Shifts in involvement of main actors bring changes in Shifts in involvement of main actors bring changes in implementation needs, views, and priorities. implementation needs, views, and priorities.
Implementation barriers emerge.Implementation barriers emerge. Policy contradictions surface.Policy contradictions surface. Conflicts emerge between policy and other strongly held Conflicts emerge between policy and other strongly held
values.values. Actors learn about policies and implementation. Actors learn about policies and implementation.