Healthcare reforms, inertia polarization and group influence

Abstract

Healthcare systems performance is the focus of intense policy and media attention in most countries. Quebec (Canada) is no exception, where successive governments have struggled for decades with apparently intractable problems in care accessibility overall, poor performance, and rising costs. This article explores the underlying causes of the disconnection between the high salience of healthcare system dysfunctions in both media and policy debates and the lack of policy change likely to remedy those dysfunctions. Academically, public policies' evolution is usually conceptualized as the product of complex, long-term interactions among diverse groups with specific power sources and preferences. In this context, we wanted to examine empirically whether divergences in stakeholders' views concerning various healthcare reform options could explain why certain policy changes are not implemented despite consensus on their programmatic coherence. The research design was an exploratory sequential design. Data were analyzed narratively as well as graphically using a method derived from social network analysis and graph theory. Results showed striking intergroup convergence around a programmatically sound policy package centred on the general objective of strengthening primary care delivery capacities. Those results, interpreted in light of political science elitist perspectives on the policy process, suggest that the incapacity to reform the system might be explained by one or two groups' having a de facto veto in policy-making.

Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa

“…These examples challenge the dominant view that lack of reforms or slow pace of progress is always a result of lack political will; demonstrating that political will can be vetoed by organised interests including private sector and pressure groups. This aligns with literature on health reforms35 109 110 from the African context111–113 and on the international scene 114–116. An interesting finding is how powerful groups and policy makers can push for reforms if there is a perception that existing policies impose concentrated costs at personal level and an anticipation of cost dispersion if reforms are effected.…”

Subjectivity through the lens of Guattari: A key concept for nursing

“…In the province of Quebec, budget cuts are ubiquitous to the healthcare system due to a series of reforms which took place from 2003 to 2015 and ended with the adoption of a law modifying the governance of the health and social services network (Goulet et al, 2014). This structural reform reduced the number of levels of decision-making bodies by merging administrations and thereby directly strengthening the control of the Minister of Health over the entire healthcare network (Contandriopoulos et al, 2014). This centralization also reinforced the bureaucratic apparatus and a professional hierarchy that had already been singled out as detrimental to the well-being of healthcare workers as early as the 1960s (Bergeron, 1990).…”

Exploring Organized Interests in Post-Communist Policy-Making

“…Similarly, Contandriopoulos (2011) argues that decisions in healthcare are made mostly based on political preferences rather than science and evidence. They also found that despite a wide political consensus among stakeholders, a veto by a few could be a barrier in implementing coherent policy reforms (Contandriopoulos et al, 2018).…”