Health Care- Case Study
Policy: Analysis, Implementation and Evaluation
• Policy Change and Federalism
• The case of Health Care Retrenchment
o Canada v. Germany v. Retirement
o What is its value? Why do we do it?
o Why is it potentially valuable for policy analysis?
o What are its weaknesses?
Provides a means to better understand the opportunities and constraints created by our system
o May have implications for the feasibility of particular policy designs or the ease of
implementing particular program
o Healthcare retrenchment is one case open to exploration
Paper presents dilemma for reformers
How to cut spending (control costs) with out paying the political costs that come
with expenditure control
o Open ended commitment to funding healthcare, problematic for government
o But, cost-containment very unpopular with citizens (little support for reductions in
o And, face powerful incumbents in health sector that stand to lose from reforms
Given thsee consistent pressures, why do we see different levels of retrenchment (ie. Cost
• Presents a two-variable model
o Number of Veto players
o Opportunities for "blame avoidance"
• Different governmental institutions provide variation on these two variables
• Premise: Actors that must agree to changes from default solutions, will only agree to
changes when it is in their interest to do so
• Different systems of government have different numbers of veto players
• Leads to expectation that change will be harder in some countries than other
Greater status quo bias
• Tsebelius (1995) defines three features of veto players that affect policy stability
o As the number of veto players increase, winset for moving from status quo does
not get larger (ie. Increased stability)
o If veto players are collectives, increasing collective group members the area of
the winset increases (ie. Decreased policy stability)
Opporotunity for "blame avoidance"
• Premise: loss aversion can lead to political backlash when program funds are cut or not
increased commensurate with increased costs
• Reformers will face potential political backlash and hence
o Will seek to find ways to obfuscate reforms, complicating lines of accountability
o Make hard to predict consequences of policy or trace political accountability after
the fact Two variables: dilemma of Reformers
•More veto players increase the challenge of getting reforms passed
•Fewer veto players -< fewer reforms
•Question for paper: how do different institutional environments affect the balance
between these two variables?
•Two Federal systems
o Germany -> power-sharing federaism
• Interlacing of federal/regional responsibilities
o Canada -> Power-sharing/federalism