Comparative health policy
Week 1 – Introduction
Weblecture of comparative health policy analysis
How can we explain that is default that immigrants live in with elderly and
others this is an exception
Different explanations
- Culture
- Long term care system private vs. public
- Can personal budget be used for
Comparative analysis stances
- Variable orientated design
o Compare many countries Large N
o Countries studied as combination of variables
o Deductive approach; test hypothesis
o Type of questions; which factors lead to a certain outcome
- Variable oriented approach
o In the example of live-in migrant care, which independent
variable appears to be decisive?
Loosely regulated cash-for-care scheme
o Translate countries into scores
- Case oriented design
, o Country studied as holistic entities
o Study their policy thoroughly
o Use of theories; more inductive
o Number of cases; small N (two countries)
Type of questions
- How can we understand that A and B are similar in many ways but
differ in policy X
- How can we understand that country C and D are different in many
ways, but have the same policy in X
- Distribution; shift going on from state to family
o Therefore might be an emerging phenomenon
Which of the following statements are correct?
A variable-oriented approach treats countries as holistic entities
A case-oriented approach treats countries as holistic entities
In a variable-oriented approach the use of theory is deductive
In a case-oriented approach the use of theory is deductive
Two types of case oriented design
, - Most similar case comparison
o Most similar in type but different outcomes
o Difficult question
o How can we explain that US and NL promote patient
empowerment, but that direct consumer ppharmaceutical
advertising only is allowed in the US.
o Conclusion; Paternalistic empowerment in NL and
individualistic in US
- Most different/ least similar case comparison
o Most different in type but with similar outcomes
o How can we explain that Austria and Sweden have different
healthcare systems and policies, have implemented similar
HPV policies
Both economic constraint therefore failed
implementation
Lecture 1 – Comparative policy introduction
Central aims of health policy sciences
1. Explaining cross-national health policy similarities and differences
(learning about)
2. Explaining health policy continuity and change (learning why)
3. Explaining health policy learning (learning from)
See Marmor et.al. 2005
Objectives of policy sciences
Understanding the development of public policies
• How are problems framed? Euthanasia framed as autonomy
• How is power distributed? Who has the power to decide
• Who gets a seat at the table?
What consequences do policies have?
• (Un)intended effects (in line with the aim and some adverse effects?)
• Changing power relations
, Object(ive) of the policy sciences
Science for policy
• Research to inform policymakers – about goals, options for interventions,
effects
• Follows agenda put forward by policy
- What are the effects in term of access, equity
Science of policy; understanding of how policy actually works
• How can we understand the development of public policies?
• Curiosity driven; not necessarily in line with policy goals
What is health policy
Often: a narrow government perspective
- A focus on one institutional arrangement: the state
‘…those courses of action proposed or taken by governments that affect
the health of their populations.’ (Blank & Burau, 2014, Comparative Health
Policy, p.2)
In this course broader governance perspective
A focus on various institutional arrangements, including the market and
civil society/association
‘…courses of action (and inaction) that affect the set of institutions,
organizations, services and funding arrangements of the health system. It
includes policy made in the public sector (by government) as well as
policies in the private sector. (…) health policy analysts are also interested
in the actions and intended actions of organizations external to the health
system which have an impact on health (for example, the food, tobacco, or
pharmaceutical industries).’ (Buse et al. 2005, Making Health Policy, p. 6)
Comparative methods – similarities and differences
- Why do they occur
What can a comparison teach us?
“… allows us to get a better idea about the range of variation that exists
and also helps to avoid both false particularism (‘everywhere is special’)
and false universalism (‘everywhere is the same’).” (Blank & Burau 2014:
279
- False particularism
o That it is everywhere and not per se a policy in one country
Week 1 – Introduction
Weblecture of comparative health policy analysis
How can we explain that is default that immigrants live in with elderly and
others this is an exception
Different explanations
- Culture
- Long term care system private vs. public
- Can personal budget be used for
Comparative analysis stances
- Variable orientated design
o Compare many countries Large N
o Countries studied as combination of variables
o Deductive approach; test hypothesis
o Type of questions; which factors lead to a certain outcome
- Variable oriented approach
o In the example of live-in migrant care, which independent
variable appears to be decisive?
Loosely regulated cash-for-care scheme
o Translate countries into scores
- Case oriented design
, o Country studied as holistic entities
o Study their policy thoroughly
o Use of theories; more inductive
o Number of cases; small N (two countries)
Type of questions
- How can we understand that A and B are similar in many ways but
differ in policy X
- How can we understand that country C and D are different in many
ways, but have the same policy in X
- Distribution; shift going on from state to family
o Therefore might be an emerging phenomenon
Which of the following statements are correct?
A variable-oriented approach treats countries as holistic entities
A case-oriented approach treats countries as holistic entities
In a variable-oriented approach the use of theory is deductive
In a case-oriented approach the use of theory is deductive
Two types of case oriented design
, - Most similar case comparison
o Most similar in type but different outcomes
o Difficult question
o How can we explain that US and NL promote patient
empowerment, but that direct consumer ppharmaceutical
advertising only is allowed in the US.
o Conclusion; Paternalistic empowerment in NL and
individualistic in US
- Most different/ least similar case comparison
o Most different in type but with similar outcomes
o How can we explain that Austria and Sweden have different
healthcare systems and policies, have implemented similar
HPV policies
Both economic constraint therefore failed
implementation
Lecture 1 – Comparative policy introduction
Central aims of health policy sciences
1. Explaining cross-national health policy similarities and differences
(learning about)
2. Explaining health policy continuity and change (learning why)
3. Explaining health policy learning (learning from)
See Marmor et.al. 2005
Objectives of policy sciences
Understanding the development of public policies
• How are problems framed? Euthanasia framed as autonomy
• How is power distributed? Who has the power to decide
• Who gets a seat at the table?
What consequences do policies have?
• (Un)intended effects (in line with the aim and some adverse effects?)
• Changing power relations
, Object(ive) of the policy sciences
Science for policy
• Research to inform policymakers – about goals, options for interventions,
effects
• Follows agenda put forward by policy
- What are the effects in term of access, equity
Science of policy; understanding of how policy actually works
• How can we understand the development of public policies?
• Curiosity driven; not necessarily in line with policy goals
What is health policy
Often: a narrow government perspective
- A focus on one institutional arrangement: the state
‘…those courses of action proposed or taken by governments that affect
the health of their populations.’ (Blank & Burau, 2014, Comparative Health
Policy, p.2)
In this course broader governance perspective
A focus on various institutional arrangements, including the market and
civil society/association
‘…courses of action (and inaction) that affect the set of institutions,
organizations, services and funding arrangements of the health system. It
includes policy made in the public sector (by government) as well as
policies in the private sector. (…) health policy analysts are also interested
in the actions and intended actions of organizations external to the health
system which have an impact on health (for example, the food, tobacco, or
pharmaceutical industries).’ (Buse et al. 2005, Making Health Policy, p. 6)
Comparative methods – similarities and differences
- Why do they occur
What can a comparison teach us?
“… allows us to get a better idea about the range of variation that exists
and also helps to avoid both false particularism (‘everywhere is special’)
and false universalism (‘everywhere is the same’).” (Blank & Burau 2014:
279
- False particularism
o That it is everywhere and not per se a policy in one country
