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Building institutions for health and health systems in contexts of rapid change

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  • Bloom, Gerald
  • Wolcott, Sara

Abstract

Many Asian countries are in the midst of multiple interconnected social, economic, demographic, technological, institutional and environmental transitions. These changes are having important impacts on health and well-being and on the capacity of health systems to respond to health-related problems. This paper focuses on the creation of institutions to overcome information asymmetry and encourage the provision of safe, effective and affordable health services in this context of complexity and rapid change. It presents a review of literature on different approaches to the analysis of the management of system development and institution-building. There is a general agreement that the outcome of an intervention depends a great deal on the way that a large number of agents respond. Their response is influenced by the institutional arrangements that mediate relationships between health sector actors and also by their understandings and expectations of how other actors will respond. The impact of a policy or specific intervention is difficult to predict and there is a substantial risk of unintended outcomes. This creates the need for an iterative learning approach in which widespread experimentation is encouraged, good and bad experiences are evaluated and policies are formulated on the basis of the lessons learned. This enables actors to learn their roles and responsibilities and the appropriate responses to new incentive structures. The paper concludes with an outline of the information needs of managers of health system change in societies in the midst of rapid development.

Suggested Citation

  • Bloom, Gerald & Wolcott, Sara, 2013. "Building institutions for health and health systems in contexts of rapid change," Social Science & Medicine, Elsevier, vol. 96(C), pages 216-222.
  • Handle: RePEc:eee:socmed:v:96:y:2013:i:c:p:216-222
    DOI: 10.1016/j.socscimed.2012.12.014
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    References listed on IDEAS

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    1. Kaplinsky, Raphael & Farooki, Masuma, 2010. "What are the implications for global value chains when the market shifts from the north to the south ?," Policy Research Working Paper Series 5205, The World Bank.
    2. Bloom, Gerald & Standing, Hilary, 2008. "Future health systems: Why future? Why now?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2067-2075, May.
    3. Wilsford, David, 1994. "Path Dependency, or Why History Makes It Difficult but Not Impossible to Reform Health Care Systems in a Big Way," Journal of Public Policy, Cambridge University Press, vol. 14(3), pages 251-283, July.
    4. Graham Room, 2011. "Complexity, Institutions and Public Policy," Books, Edward Elgar Publishing, number 14394.
    5. Cornwall, Andrea & Shankland, Alex, 2008. "Engaging citizens: Lessons from building Brazil's national health system," Social Science & Medicine, Elsevier, vol. 66(10), pages 2173-2184, May.
    6. Gilson, Lucy, 2003. "Trust and the development of health care as a social institution," Social Science & Medicine, Elsevier, vol. 56(7), pages 1453-1468, April.
    7. Lucy Gilson & Kara Hanson & Kabir Sheikh & Irene Akua Agyepong & Freddie Ssengooba & Sara Bennett, 2011. "Building the Field of Health Policy and Systems Research: Social Science Matters," PLOS Medicine, Public Library of Science, vol. 8(8), pages 1-6, August.
    8. Bloom, Gerald & Standing, Hilary & Lloyd, Robert, 2008. "Markets, information asymmetry and health care: Towards new social contracts," Social Science & Medicine, Elsevier, vol. 66(10), pages 2076-2087, May.
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    Cited by:

    1. Lewis Husain & Gerald Bloom & Yue Xiao, 2023. "Building policy capacity for managing rapid, complex change in China’s health system," Policy and Society, Darryl S. Jarvis and M. Ramesh, vol. 42(1), pages 28-48.
    2. Massaro, Sebastiano & Lorenzoni, Gianni, 2021. "Nanomedicine: a socio-technical system," Technological Forecasting and Social Change, Elsevier, vol. 173(C).

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