Description
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This paper offers a brief account of how interest and institutional structures interact to explain the divergent evolution of developed democracies’ postwar commitments to social health-care provision. Institutions that fostered democratic participation also enhanced and balanced governmental responsiveness to inequality, economic hardship, and the population’s age-demographic structure, inducing greater effective demand for public-health-spending growth in some democracies than others. Governments also responded to these differentially rising demands for public health-care to an extent and in ways that differed depending on multiple other interactions of political-economic conditions, institutions, and interest structures. Divided or fractionalized governments, in particular, retarded policy adjustment-rates and so greatly magnified the long-run impact of the common and differing demands for public-health provision. This varying growth in public health-care spending reduced (perceived) policy efficacy and maneuverability, shifting health-policy emphases toward reform of (perceived poor-performing) existing systems. Again, interest and institutional interactions conditioned the impact of this shift across democracies. Reforms have had only limited effect on spending growth, yet likely had and will continue to have sizable distributional effects that, once again, depend on key institutional interactions such as those described above. The paper thus shows, broadly, how complex structures of political-economic interests and institutions interact to induce different policies from democratic governments facing similar challenges and, specifically, how this unfolded in developed democracies over the postwar era as an evolution from commitments to quality public health-care provision toward more conservative and narrower goals of moderating health-care costs. And it shows that battles over these choices always were and remain still primarily political battles about (re)distribution and (in)equality, and only subsidiarily about efficiency, whatever p artisan protagonists may claim.
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Related Publication
| Robert J. Franzese, Jr. 2003. "Participation, Veto Actors, and Policy Responsiveness in the Evolution and Reform of Health Care in Developed Democracies," in Fukusi Saiken No Seijigaku (Reconstructing the Welfare State), Hideko Magara, ed., Forthcoming. chapter available here
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Notes
| Subject: STANDARD DEPOSIT TERMS 1.0 Type: DATAPASS:TERMS:STANDARD:1.0 Notes: This study was deposited under the of the Data-PASS standard deposit terms. A copy of the usage agreement is included in the file section of this study.; |