the social context of health politics health politics
Download
Skip this Video
Download Presentation
The social context of health politics Health Politics

Loading in 2 Seconds...

play fullscreen
1 / 34

The social context of health politics Health Politics - PowerPoint PPT Presentation


  • 139 Views
  • Uploaded on

The social context of health politics Health Politics. Ana Rico, Associate Professor Department of Health Management and Health Economics [email protected] O. Introduction The political system and the social systems I. Research question

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' The social context of health politics Health Politics' - gina


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
the social context of health politics health politics

The social context of health politicsHealth Politics

Ana Rico, Associate Professor

Department of Health Management and Health Economics

[email protected]

outline theories of the social context
O. Introduction

The political system and the social systems

I. Research question

Is the social context the main cause of policy?

Does politics matter?

II. Main concepts - definitions

Context, social structure, power, politics, representation, national culture, convergence

III. Thesis and arguments

The social context directly determines policy 

We can treat politics as a black box

IV. Aplications – Theories and evidence

Structural theory: class and race

National culture: Liberal (pro-market), non-Liberal (pro-state)

Convergence theory: Pressures and policies

OUTLINE: Theories of the social context
what is the social context
Context (= pressures external to the health care system)

A subjective concept: variables in the background, which are assumed to be exogenous = independent from politics

NOTE: There is wide agreement nowadays that most causal relationships in political science are endogenous

Depending on the authors, the social context includes:

A. Conjunctural factors: wars, crisis, etc..

B. International pressures: agreements, loans, competitors, multinationals

C. Socioeconomic factors: income and social class, technology, demography, epidemiology

D. Cultural factors: values, ideology, expectations

WHAT IS THE SOCIAL CONTEXT?

Mechanic, 1996. Comparative health systems

causes of policy change operationalization in ws hc research
CAUSES OF POLICY CHANGE: Operationalization in WS/HC research
  • Access & participation
  • Policy strategies
  • Coalition-building
  • Competition and cooperat.
  • Changing resources
  • Learning
  • Conjunctural factors: ec crisis, wars
  • Socioeconomic structure:
    • Ownership, income
    • Education, knowledge
    • Social capital (status, support)

CONTEXT

  • Sociopolitical structure:
    • Cleavages and political identities
  • Values: Culture and subcultures
  • Interest groups
  • Profesional assocs.
  • Poilitical parties
  • State authorities
  • Citizens: PO/SM
  • Mass media
  • Distrib. of formal pol. power: electoral law, constitution, federalism, corporatism
  • Contracts and org. structures
  • Norms of behaviour
  • Sanctions/incentives

POLITICS: InteractionsProcess

Preferences

Resources

POLITICAL ACTORS

INSTITUTIONS

Individual and collective

-

Formal and informal

  • Entitlements & rights
  • Regulation by law (of power, ownership, financing, behaviour, contracts)
  • Redistribution: Financing & RA
  • Production of goods & services

POLICY

Adapted from Walt and Wilson 1994

slide5

THE POLITICAL & SOCIAL SYSTEMS

SOCIAL

CONTEXT

THE POLITICAL SYSTEM

a

Dynamic interactions

Sociopolitical actors

ECONOMY

SOCIETY

c

Implemen-

tation

Policy change

CULTURE

b

HC services

Institutions

Political actors

Outputs

d

e

f

Outcomes

POLITY

POLITICS

POLICY

INPUTS

OUTPUTS

  • Demands and supports
  • Access to the political system
  • Decision-making

d. Institutional change

e. Social impact of policy

f. Distribution of costs and benefits

outline 1 structural theories
I. Research question

Does the relative power of social groups determine policy?

II. Main concepts - definitions

Structure, cleavages, social groups, identities and ideological subcultures

III. Thesis and arguments

The distribution of ownership (+ other resources) across social groups determines their relative power to approve policies which favour them

When priviledged groups have most resources, pro-rich policies prevail, and inequalities widen  Underpriviledged groups will revolt (if they develop a political identity under capable leadership), in order to impose pro-poor policies

When less ec. inequality + democracy, policy depends on the changing balance of power

The distance between the middle class, and the rich/the poor, will determine who they support politically, and thus which policies will prevail

V. Criticisms (antithesys and sinthesis)

Social groups only influence policy via representatives (sociopolitical & political actors) +

Powerful social groups can have weak representative organizations

VI. Policy implications

Redistribution of resources to less powerful social groups (or their representatives) is required to avoid conflict and for democracy to work

OUTLINE (1): Structural theories
power resources informal social formal institutional
POWER RESOURCES:INFORMAL (social) & FORMAL (institutional)

Collective action resources

Knowledge-based resources

  • Informal, experience-based
  • Formal, evidence-based
  • Internal cohesion
  • Coalition capacity
  • External support

Financial resources

Institutional resources

  • Formal political power
  • Formal organizational power
  • Ownership
  • ”Sponsorship”

Adapted from Hughes-Tuohy 2003 and Hicks & Mishra 1993

slide8

Policy

MACRO: Political actors

The political game

MESO: Sociopol. actors

$

HC SYSTEM

Advisors and

managers

Political parties’ members

Citizens’ Associations

IGs - Bussiness - Insurance

Profes. + providers’ Assoc.

Patients’ Assoc.

Patients’

Sociopol. context = Policy sub-system

MICRO:Social actors

The social context

what is the social structure
Social structure, social groups and social power resources

Social structure = Distribution of social power resources (ownership & income, knowledge & information, status & social support) across social groups

Social groups are sets of individuals with shared characteristics (class, etnia, religion, community, gender) around which shared identities and subcultures are formed

Some social groups develop conflicting ideological/political subcultures which tend to form opposition poles (cleavages or axis), usually associated to power resources imbalances

WHAT IS THE SOCIAL STRUCTURE?

Social groups

Social structures, political institutions,

social policies

Political actors

Individuals

Organizations

concepts
Politics:

Process through which political actors make, take and enforce collective decisions which committ all members of a society

Power: 2 types

Power for: As capacity to advance goals through intended action = capacity to decide among alternative courses of action

Power over: As control upon. Capacity to obtain obedience (of conditioning others’ actions) even when it goes against self-interest

Democratic representation:

Relationship between political actors (representatives) and social groups (represented/constituency)

by which group members delegate their decision rights

in exchange for representatives’ committment to defend their interests and values in the political process

 with or without mandate: delegates versus representatives

CONCEPTS
concepts1
NOTE: Democratic politics requires representationCONCEPTS

Decision costs

Risk of despotism

Number of decision-makers

100

Sartori, 1987

outline 2 cultural theories
I. Research question

Do national culture determine policy?

II. Main concepts - definitions

Culture, liberalism/statism

III. Thesis and arguments

Policies are only feasible if compatible with historical national cultures

National cultures pre-date democracies, and do not change

IV. Aplications – evidence

Social expenditure in Anglosaxon countries vs. the rest

V. Criticisms (antithesys and sinthesis)

National culture is divided in ideological, conflicting subcultures

National culture is the same as public opinion, and is directly influenced by politics (e.g. Persuasion, manipulation by political and social actors)

National culture changes as a result of market/state performance (policy feedbacks)

VI. Policy implications

In Anglosaxon countries, only liberal welfare states can exist, in which state intervention is small, and relies on the market for provision of services

NOTE: Initially, Esping-Andersen theory was a combination of structuralism and culturalism

OUTLINE (2): Cultural theories
slide13

1. & 2.: THE WS, Measurement & Types

Conservatism

ITA

AUS

GER

BEL

FRA

FIN

IRE

JAP

NZ

NETH

NOR

USA

CAN

UK

DNK

SWE

AUZ

SWI

Neo-liberalism

Socialdemocracy

Based on Hicks & Kenworthy 2003

outline 3 convergence theory
I. Research question

Do countries converge towards same policies?

II. Main concepts - definitions

Context, globalization, convergence

III. Thesis and arguments

As pressures globalize, policies converge

IV. Aplications – evidence

Pressures and policies

V. Criticisms (antithesys and sinthesis)

Same pressures explain convergence, but not divergence

Health care politics can account for both

VI. Policy implications

Convergence theory: An open economy, in the presence of international competition, guarantees adoption of best practice policies

Political theory: Best practice will only be adopted if acceptable to political actors; compatible with previous institutions; and led by capable governments

OUTLINE (3): Convergence theory
convergence theory rqs concepts
Convergence

Defined as “the tendency of societies to grow more alike”, or as

“The movement over time towards some identified common point”

Note that:

The essential theoretical emphasys is temporal, not spacial

A “process of becoming”, not “a condition of being”

Analytical dimensions of convergence:

1. Convergent pressures/social context

2. Convergent politics (=actors, institutions and process)

3. Convergent policies:

Convergent policy goals

Convergent policy content & instruments

4. Convergent outcomes

Industrialization < modernization < globalization

CONVERGENCE THEORY: RQs & CONCEPTS

Bennett, 1992. What is policy convergence and what causes it?

convergence theory thesis arguments
Convergence led by industrialization & globalization:

Industrialism:“As societies progressively adopt a progressively more industrial infrastructure, certain [automatic] processes are set in motion which tend overtime to shape social structures, political processes and public policies in the same mould”

Globalized context pressures  globalized economy  convergent social structures, politics, policies and outcomes

CONVERGENCE THEORY: THESIS & ARGUMENTS

Bennett, 1992. What is policy convergence and what causes it?

convergence theory thesis arguments1
Competition among countries and social darwinism

Like in markets, most efficient innovations (best practice) spread automatically, without direct interaction

Competition provides powerful incentives to converge in expenditure/imitate best practice

Degree of adoption across countries depends on level openess of the economy to the international market

The political system as a black box

National politics do not have an impact in policy (as countries adopt the same policies independently of different national political and health care systems)

CONVERGENCE THEORY: THESIS & ARGUMENTS

Mechanic, 1996. Comparative health systems

convergence theory aplications
(1) PRESSURES

A. Financial and macroeconomic pressures

Slowly growing (or rapidly decreasing) GDP + Fiscal pressures to decrease taxes in order to boost exports and attract foreign investors

B. Demographic and epidemiologic transition:

Aging, through its effects on morbidity, (costs?) and financing

Growing and changing inequalities

C. Technology developments

Solid evidence (OECD 2003) main cause of expansion in costs

Important differences across countries on rate of investment

D. Increased citizen expectations

E. A widening and deepening EU

NOTE: In political science, D & E are treated as endogenous to the political system, rather than exogenous/external factors.

CONVERGENCE THEORY: APLICATIONS
trends in total health expenditure as of gdp 1970 1999
Trends in total health expenditure as % of GDP, 1970 - 1999

12

Germany

10

France

Sweden

8

Spain

Percentage

United Kingdom

6

4

2

0

1970

1975

1980

1985

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

Year

trends in population aged 65 by european subregions 1970 1999

Sweden

Italy

18

EU average

17

16

15

14

CEE average

13

NIS average

% of population aged 65+

12

11

10

9

8

7

1970

1975

1980

1985

1990

1995

2000

Year

TRENDS IN POPULATION AGED >65 BY EUROPEAN SUBREGIONS, 1970 - 1999

Source: WHO Health For All Database 2000

difference in smoking prevalence among high and low status groups 1995 poor smoke more rich more
DIFFERENCE IN SMOKING PREVALENCE AMONG HIGH AND LOW STATUS GROUPS, 1995 (+ poor smoke more; - rich more)
convergence theory aplications1
(2) POLICIES

1. Cost-containment policies

2. From hierararchy to competition to cooperation

3. Transfer of autonomy to providers (power + risk)

4. Private management instruments

5. Regulated competition and cooperation

6. Expanding the role of patients

7. Transfer of financing responsibility - copayments

8. New rights and powers (eg choice)

9. Integrated care = coordination across levels of care

10. Strengthening of primary and community care

11. Promotion of new public health

12. Evaluation of performance

CONVERGENCE THEORY: APLICATIONS
slide30
EVIDENCE ON THE CONVERGENCE THESIS

Not enough research + evidence in health care (only on expenditure):

Nixon (1999) and Hitris and Nixon on EU concludes YES  suggests club convergence.

General conclusion of a 1992 review (covering several policy sectors):

“Although there is considerable evidence of policy convergence, which should convince us that it remains a significant topic for political sciencists, it is by no means a general finding. The literature provides plenty of evidence on divergent responses” (Bennett, 1992)

Conclusions of a 2003 review on social expenditure and welfare policies:

“The short term and middle term analysis show an spiralling link between the trend of social expenditure and economic development, and the existence of cycles... The cycle of social expenditure shows that a part of convergence is not due to any convergence in social policies...[but] The long-term convergent trend of social expenditure and its cycles have not blurred the distinction between the systems during the previous decades” (Bouget, 2003)

CONVERGENCE THEORY: APLICATIONS

convergence theory v criticisms
General criticisms from political science:

“This [covergence] logic can easily collapse into an argument for economic or technological determinism” (Bennett, 1992)

“Dominant groups in control of policy-making are able to impose an interpretation of context... which is not politically neutral”

Pressures interact differently with diverse national institutions

E.g. Aging (pressure) has very different impact on expenditure in a country with developed community care and health promotion; and with less investment in technology(eg Scandinavia vs. The US)

The same policy ideas are applied through very different policy instruments

E.g. Role of patients in financing US, Norway & Denmark (Mossialos et al, 2003)

CONVERGENCE THEORY: V. CRITICISMS
slide33
IN SUM:

There are nationally specific interactions between (shared) pressures and particular actor and institutional configurations

There are some signs of converge but more of divergence

Politics matters and can explain both convergence and divergence

CONVERGENCE THEORY: SINTHESYS

convergence theory vi policy implications
CONVERGENCE THEORY: VI. POLICY IMPLICATIONS
  • Three positions on the dynamics of policy adoption across countries...
  • Two of them represent extremes:
    • All countries converge to a single model of best practice (ECONOMICS)
    • Each country develops its own policy models based on a trial and error process and on historical experiences, as policy problems differ across countries, and feasible policy solutions depend on nationally specific context, actors and institutions (INSTITUTIONALISM)
  • And the third, an intermediate position...:
    • Club convergence: there is a limited trend to convergence across nations with similar actor and institutional configurations which face similar context pressures (COMPARATIVE POLITICS)
ad