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Institutional logics and responsive government : hospital sector reforms in England, Japan and Sweden, 1990-2006

This thesis examines the mechanisms of policy change in the hospital sector in three countries (England, Sweden and Japan), and argues that pressure on central government to respond to public concerns can significantly alter conventional institutional arrangements. By analysing four types of pressure (two mainly political, i.e. local campaigns against hospital closure and corporatisation of public hospitals; two mainly technical, i.e. quality assurance system-building, and malpractice incidents), the thesis sheds light on the fact that, when institutional vulnerabilities are exposed to public criticism, central governments exhibit their capacity to reform the hospital sector irrespective of institutional constraints. Under these circumstances, the varieties of the institutions in the three countries do not matter, as the observed responses were similar. In order to compare and contrast the 'responsiveness' of central government within the different 'logics' of the respective health care systems, this thesis investigates selected parliamentary and unitary states with universal health coverage, each however with different degrees of state involvement in the hospital sector: England (nationally-run) as part of the United Kingdom, Sweden (locally-run) and Japan (predominantly privately-run). By differentiating the types of pressure and examining the saliency of each issue in the printed media, it is demonstrated that the responsiveness of government to pressure is largely affected by the institutional arrangements in which they operate. However, when the saliency of non-redistributive technical issues is high, institutional constraints are overcome and institutional choices by government are reversed under heightened pressure. The analysis of dynamic policy change questions the constraining nature of political institutions on health reforms, and explains how policy convergence comes about to an extent that goes beyond path dependency in this predominantly profession-driven policy sector.
Date January 2008
CreatorsKodate, Naonori
PublisherLondon School of Economics and Political Science (University of London)
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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