Regulating self‐selection into private health insurance in Chile and the United States

Abstract

For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization.

A Comparative Case Study Analysis of Barriers and Facilitators to Implementing the Affordable Care Act’s Balancing Incentive Program

“…One case selection strategy used in comparative policy research is the most different cases method. In this approach, cases that are different in many respects but perform the same on the dependent variable are explored (Bode & Firbank, 2009; Bustamante & Mendez, 2015; George & Bennett, 2005; Klinger et al, 2014). The most different case study design has benefits when studying policy implementation because it increases confidence that common factors among the cases may account for implementation success or failure (Goggin, 1986).…”