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Review Article: Dismantling the Health Care State? Political Institutions, Public Policies and the Comparative Politics of Health Reform

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  • HACKER, JACOB S.

Abstract

This article examines the recent pattern and progress of health care reform in affluent democracies, focusing in particular on Britain, Canada, Germany, the Netherlands and the United States. Its main contention is that efforts to reform health care in advanced industrial states have been marked by a paradoxical pattern of ‘reform without change and change without reform’, in which large-scale structural reforms have had surprisingly modest effects yet major ground-level shifts have, nonetheless, frequently occurred as a result of decentralized adjustments to cost control. The main task of the article is to investigate the reasons for and effects of this puzzling pattern by plumbing the largely unexplored theoretical territory between comparative health policy analysis and cross-national research on the welfare state. Along the way, the article develops a simple model of the politics of reform that helps explain cross-national variation in legislative and policy outcomes – particularly outcomes that occur through decentralized processes of internal policy ‘conversion’ and policy ‘drift’, rather than through formal legislative reform. It also takes up a number of other intriguing issues raised by recent trends: why, for example, market reforms are clustered in centralized political and medical frameworks; why these reforms have generally enhanced state authority rather than market autonomy; why, despite fragmentation, decentralized political and medical systems shifted towards an expanded government role; and why significant retrenchment of the public-private structure of health benefits occurred in the United States.

Suggested Citation

  • Hacker, Jacob S., 2004. "Review Article: Dismantling the Health Care State? Political Institutions, Public Policies and the Comparative Politics of Health Reform," British Journal of Political Science, Cambridge University Press, vol. 34(4), pages 693-724, October.
    • Handle: RePEc:cup:bjposi:v:34:y:2004:i:04:p:693-724_00
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    Cited by:

    1. Frisina Doetter, Lorraine & Götze, Ralf, 2011. "The changing role of the state in the Italian healthcare system," TranState Working Papers 150, University of Bremen, Collaborative Research Center 597: Transformations of the State.
    2. Alena Kimakova, 2010. "A Political Economy Model of Health Insurance Policy," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 38(1), pages 23-36, March.
    3. Jacob S. Hacker, 2009. "Yes We Can? The New Push for American Health Security," Politics & Society, , vol. 37(1), pages 3-31, March.
    4. Hudgins, Anastasia & Rising, Kristin L., 2016. "Fear, vulnerability and sacrifice: Drivers of emergency department use and implications for policy," Social Science & Medicine, Elsevier, vol. 169(C), pages 50-57.
    5. Adam Oliver, 2005. "The English National Health Service: 1979‐2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 75-99, September.
    6. C. Emdad Haque & Mahed-Ul-Islam Choudhury & Md. Sowayib Sikder, 2019. "“Events and failures are our only means for making policy changes”: learning in disaster and emergency management policies in Manitoba, Canada," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 98(1), pages 137-162, August.
    7. Daniel Béland & Michael Howlett & Philip Rocco & Alex Waddan, 2020. "Designing policy resilience: lessons from the Affordable Care Act," Policy Sciences, Springer;Society of Policy Sciences, vol. 53(2), pages 269-289, June.
    8. Schmidt, Tobias S. & Sewerin, Sebastian, 2019. "Measuring the temporal dynamics of policy mixes – An empirical analysis of renewable energy policy mixes’ balance and design features in nine countries," Research Policy, Elsevier, vol. 48(10).
    9. Sebastian Sewerin & Daniel Béland & Benjamin Cashore, 2020. "Designing policy for the long term: agency, policy feedback and policy change," Policy Sciences, Springer;Society of Policy Sciences, vol. 53(2), pages 243-252, June.
    10. Miller, Fiona A. & French, Martin, 2016. "Organizing the entrepreneurial hospital: Hybridizing the logics of healthcare and innovation," Research Policy, Elsevier, vol. 45(8), pages 1534-1544.
    11. Immergut, Ellen M. & Schneider, Simone M., 2020. "Is it unfair for the affluent to be able to purchase “better” healthcare? Existential standards and institutional norms in healthcare attitudes across 28 countries," Social Science & Medicine, Elsevier, vol. 267(C).
    12. Eren Vural, Ipek, 2017. "Financialisation in health care: An analysis of private equity fund investments in Turkey," Social Science & Medicine, Elsevier, vol. 187(C), pages 276-286.
    13. Garfinkel, Irwin & Zilanawala, Afshin, 2015. "Fragile families in the American welfare state," Children and Youth Services Review, Elsevier, vol. 55(C), pages 210-221.

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