2005Institutional theories. The role of political institutions

Lecture 7

Health Politics

Ana Rico

ana.rico@medisin.uio.no

2005

The old institutionalism

I. Research question

Which is the impact of political institutions and the social structure on democratic politics and policy change?

II. Main concepts - definitions

Majority and consensus democracies, plurality and proportional electoral systems, presidentialism, parliamentarism, federalism

III. Thesis and arguments

Institutions which disperse power across political and sociopol. actors are more democratic (responsive) & equally effective

III. Anti-thesis: the new institutionalism

Concentrated state power needed for effective policy change

IV. Aplications – evidence

Political institutions in Western Europe (Liphart, 1984; 1999)

VI. Policy implications

Power concentration is good for passing controversial policy, but can have high political and implementation costs

2005

SOCIAL PRESSURES OLD INSTITUTIONALISM Formal political institutions

SOCIAL ACTORS (IGs: dependent on

social pressures)POLITICAL ACTORS (STATE: independent

of social pressures)

SOCIOP. ACTORS (STATE-SOCIETY: interdependent) NEW INSTITUTIONALISM

(state institutions & state/PPs/IGs’ organization)

POWER-CENTRED THEORIES (interactions among collective actors & social structure)

RATIONAL CHOICE (interactions among individuals

ACTOR-CENTERED INSTITUTIONALISM (interactions among institutions & elites)

1950s/60s: SOCIAL CONTEXT

1970s/1980s: ACTOR-CENTRED

1990s: INSTITUT-IONALISM (+state-society)

2000s: ACTION THEORIES

SOCIAL & POLITICAL THEORIES

L3

L5L2, L4

L6

L7

L9L4, L9

L7

L7, L9

2005

SOCIAL CONTEXT: The state as a ‘transmission belt’ of social pressures

STATE-CENTRIC: The state as a unitary, independent actor with formal monopoly of (residual) power over policy-making

STATE-SOCIETY: The state as a set of political representatives and policy experts with preferences and action partly independent, and partly determined by a wide range of social actors’ pressures

INSTITUTIONALIST: The state as a set of political institutions; or as a set of elites with preferences and actions mainly determined by institutions

ACTION: As a set of political organizations which respond to context, sociopolitical actors and institutions; and which compete and cooperate (=interact) to make policy

CONCEPTS (4): The state

2005

ANTECEDENTS (3)

Old political institutionalism (Lijphart)

• Formal centralization of decision-making power makes political regimes, states and organizations more capable & more efficient

• State powers are more centralized when:

Democratic Institutions: Majoritarian (vs proportional) electoral systems; Unitary (vs federal) states; Executive dominance (+/- = parliamentarism vs. presidentialism);

Sociopolitical organizations: Biparty/multiparty systems, majority vs. coalition) government; Corporatism (vs pluralism); Party discipline and centralized organization

Social groups: Single (=class) vs multiple cleavages in the soc. struct. seen as causes of institutions

Single/multiple cleavages biparty/multiparty system single party/coalition gov. centralized democratic institutions

2005

Types of democratic institutions in the EU

The old institutionalism

MAJORITARIAN CONSENSUS

Unidimensional party systems Multidimensional party systems

Two party systems Multiparty systems

Majority(/plurality) elections Proportional elections

Concentration of executive power:

majority government

Executive power-sharing: coalition

governements, corporatism

Executive dominance over parliament

(Presidentialism)

Division of powers (Parliamentarism)

Unicameralism or asymm. bicameralism Balanced bicameralism

Unitary and centralized Federal and devolved

Unwritten constitution Written constitution and protection of

minorities

Representative democracy, pluralism Forms of direct (corporatist) democracy

Lijphart, 1984 Later US research shows that Presidentialisms disperses power more

2005

Other arguments and counterarguments (1)

1. LIJPHART’S THESIS

• The interplay between social structure, political institutions and sociopolitical

groups determines policy

• Institutions which concentrate power can be more effective, but are less

democratic costs in terms of political support & implementation gaps

• Institutions which disperse power across actors are more democratic

(minorities´representation, direct political participation), and, under some

conditions (cooperation, consensus building), can be equally effective

(minorities’ protection, economic growth, income inequality)

2. CRITICISMS (anti-thesis)

New institutionalism• Institutions which concentrate state and socioP power are needed for state

capacity/autonomy + effective policy changeActor-centred institutionalism• Institutions which disperse state power allow more points of acess (veto

points) for IGs to block policy

The old institutionalism

2005

Arguments and counterarguments (2)

1. LIJPHART’S THESIS (2)

Types of political institutions and degree of concentration of power

Majoritarian vs. consensus institutions: Functional division of power –DoP- among state organizations and political parties

Unitary vs. federal institutions Territorial DoP – between federal/central and state/local governments)

[Corporatist vs. Pluralist: DoP between state and social groups)]

2. CRITICISMS

NOTE: Later institutionalists socioP institutions such as party discipline,

or minor constitutional reforms in EU 1950s allowing the Executive to

pass legislation by decree, are critical too to promote power

concentration

The old institutionalism

2005

The electoral system (translates social support/votes into % of state power)

A. Proportionality = votes/parliam. seats ( access to govern. & parliament) Main dimensions Maj Prop Maj Prop

Electoral formula < % Prop > Electoral thresholds > <

District magnitude Small Big Ballot structure 1/2 rounds

Supplementary seats No Yes

C. The social and socioP power structure: Cleavages & pol. parties

The old institutionalism

NON-PLURAL (2-3

parties, 1 cleavage)

SEMI-PLURAL (3-5

parties, 1-2 cleav.

PLURAL (> 5

parties, 2-3 cleav.)

Relig./linguistic

homogeinity

HIGH

UK, Ireland

New Zealand

Scandinavian

Finland

France

Italy

Austria

Israel

Luxemburg

Religious/ling.

heterogeinity

LOW

Australia Germany

Canada

United States

Belgium

Netherland

SwitzerlandLijphart, 1984

2005

PRESIDENTIALISM:

President elected by

citizens, strong Parliament

PARLIAMENTARISM

Prime Minister strong,

elected by Parliament

MAJORITARIAN

(plurality)

United States

Philippines

Puerto Rico

Ex-Soviet

United Kingdom

Canada

Australia

New Zealand

Asia

Africa

PROPORTIONAL France

Switzerland

South America

Most Western Europe

Th

e e

lect

ora

l sys

tem

The DoP between Executive & Parliament

Lijphart, 1994

2005

Modern institutionalist theory

I. Research questions Are institutions the main cause of policy? Do they determine actors’ behaviour?

II. Main concepts - definitions Types of political institutions; path dependence and institutional inertia.

III. Thesis and arguments New institutionalism: (1) Institutions determine actors’ preferences, resources and

strategies, and therefore reinforce and reproduce the status quo

Actor-centred institutionalism (infl. by ECO): (2) Formal political institutions modify (weaken or strengthen) the degree of autonomy of state actors from IGs

IV. Aplications – evidence Explaining the emergence of different health care systems

V. Policy implications (1) Institutions do not change, hence big policy turns are unlikely;(2) Changing formal

constitutional rules increases the likelihood of state-led policy change,

VI. Criticisms Institutions can be changed through political action and policy reform; lack of change is

due to entrenched interest groups and/or reluctant citizens

2005

a. Demands and supportsb. Access to the political systemc. Decision-making

d. Institutional changee. Impact of policyf. Distribution of costs and benefits

State actors:•STATE-, POL. PARTs (IGs)

Policy change

INPUTS

Outcomes

THE POLITICAL SYSTEM

POLICY (SUB-) SYSTEM

a c

d e

b

OUTPUTS

Outputs

POLICYPOLITICSPOLITY

f

HC SYSTEM

Formal & informal institutions SOCIAL CONTEXT

Institutions:• Const. (interorg.)• Organiz. Struct.

Interactions:• Coalitions/competit.• Leadership/strategy

Sociopol. actors:

• IGs, Prof Ass., Unions• Citizens, Mass media• Political parties

CONSTITUTION

CULTURE

* Org.Struct.

* Subcultures /pol.identities

* Ideologies * Ideas

Social organiz. • Associations • Churches• Firms

Social groups - Communities- Ethnia, gender- Social classes

* Policy paradigms/ legacies

2005

Institutions (including public policies, organizations) block new policy because of their strong resistance to change (inertia) once settled (path dependence)

Institutional inertia/path dependence is in turn due to:

A. Technical/cognitive causes (decreasing returns = economies of scale/scope, learning costs)

ECO + some POL. Sci. (eg Pierson 1998, Wilsford, 1995)

B. Normative causes (cognitive rules are given normative meaning through the processes of socialization carried out to guarantee the compliance of individuals to rules; once linked to values, rules become difficult to change)

Anthropology, Sociology, ORG THEORY, Policy Anallisys

Social embebbedness (Evans)

Policy change happens only as a result of an external shock which opens a policy window for reform

The new institutionalism

20052004

1. Political institutions which allow f or the dispersion of power generate multiple points of access of interest groups through which they can veto state policies

2. Under dispersed f ormal political power, the chances of policy change (eg WSexpansion) are low I mmergut 1992

3. NOTE: Here Presidentialism considered to disperse rather than concentrate power (evolution f rom Lijphart based on legislation by decree & party discipline)

Corporatism (EU)Pluralist (USA, UK)

Party discipline (EU, Canada)No party discipline (USA)

Majority electoral system (US, UK) PR electoral system (EU)

Unitary (UK, Sweden, France)Federal (US, Switz., Canada)

Strong executive Weak parliament and courts (EU, Fra 2)

Weak executive (US, Switz., Fra 1)Strong parliament and courts

CONCENTRATEDDISPERSED

Political institutions

Socio-political institutions

ACTOR-CENTRED INSTITUTIONALISM

Immergut, 1992

2005

DETERMINANTS SWEDEN FRANCE SWITZERLAND

Policy idea + + +

Government’s support

Interest groups - - -

Left vote & unions + - -

Territ. DoP (‘state capacity’) Unit. Dev. (-) Unit. Centr. (+) Federal (--)

Veto points/(DoP E/P/C) Few (+) * 1st : Multiple (-)

* 2nd : Few (+)

Multiple (--)

Party system (& discipline)* Influenced by electoral system

Concentr (+) Dispersed (-) Highly disp. (--)

POLICY CHANGE NHS (++) SHI (+)

* 1st : -

* 2nd : +

PI (-)

Determinants of National Health Insurance systems

Immergut, 1992

Actor-centred institutionalism

2005

a. Demands and supportsb. Access to the political systemc. Decision-making

d. Institutional changee. Impact of policyf. Distribution of costs and benefits

Sociopol. actors: • NEW SOCIAL MOV.• MASS MEDIA• IG & PROF ASS• POLITCAL PARTIES

Institutional framework

Policy actors:•STATE ACTORS• IG & PROF ASS• POLITCAL PARTIES

Interactions

Policy change

INPUTS

Outcomes

THE POLITICAL SYSTEM

POLICY CONTEXT

ac

d e

b

OUTPUTS

Outputs

POLICYPOLITICSPOLITY

f

HC services

Implemen-tation

Social organiz.• ASSOCIATIONS • CHURCHES• FIRMS

Social groups• COMMUNITIES• ETHNIA, GENDER• SOCIAL CLASSES

Veto pointsSOCIAL CONTEXT

2005

(State) actors and political parties are the main determinant of policy

Institutions increase or decrease their opportunities to influence policy

EVIDENCE: Canada (NHI) vs the US (no NHI) in the 1960s

In the US as in Canada, the main advocate of NHI were small socialdemocratic parties territorially concentrated

In the US as in Canada, the majority of citizens strongly supported NHI in these states/provinces

In Canada, due to open political acess & strong federalism in HC, a tiny socialdemocratic party ruling in one province introduces NHI, demonstrating that can work with good effects outside Europe this helps them convince the reluctant democratic party & public opinion to support it at national level

In the US, weak federalism impedes pro-WS minority parties to govern no demonstration effects possible

Actor-centred institutionalism

Maioni, 1997

2005

CAUSES OF NHI: CANADA vs USA

VARIABLES CANADA 1960S: NHI USA 1960s: NO NHI

CONTEXT.

Social values, culture Individualism Individualism

INSTITUTIONS (RULES)

1. Executive dominance

2. Federalism

3. Party discipline

Medium/weak

Strong

Yes

Weak

Weak

No

ACTORS (PLAYERS)

1. State authorities

2. Pro-WS Pol. Parties + IGs

Weak

Access to governm.

Weak

No access

PAST POLICY

1. Past WS policies in HC (a

cause of state auton. & capacity)

Underdeveloped Underdeveloped

Maioni, 1997

2005

FISCAL FED.

60s 70s 80s 90s 00s

POLITICAL DEVOLUTION

NORDIC COUNTRIES

ITALY /SPAIN

FISCAL FED.

CENTRAL COORD.

FEDERALISM IN EU HC

POL. DEVOLUTION

POL. DEV.?UK / GREECE / (PORTUGAL)

CENTR??

2005

FEDERALISM & impact of DoPower

CENTRAL SHARED LOCAL

RESPONSIVENESS Interests represented Decision costs

- -

++ ++

+

+ ? ACCOUNTABILITY Visibility (citizens) Control (central state)

++ ++

- +

-- ? - ?

Political OUTCOMES (for democratic representation)

2005

New institutionalism, path sependence:

Institutions do not change, hence once they are established big policy turns are unlikely

Historical determinism: countries are prisioners of history (and individuals of their early socialization experiences/the prevailing social norms)

Actor-centred institutionalism (old-institutionalism): debate on

Immergut: Changing formal political institutions towards further concentration of power increases the likelihood of policy change, even if powerful opposed interests

Maioni (with Lijphart): Institutions which disperse power increase access of minority political parties in government and hence the likelihood of policy change

POLICY IMPLICATIONS

2005

Old-institutionalism

Presidentialism implies dispersion of power across state organizations (President and Parliament), while Parliamentarism implies dispersion of power across political parties and Igs

New institutionalism, path dependence: Political actors can modify some of the rules of the game or ignore them

Part of the causes included under ´institutions´ are rather culture, actors or past policy + state performance

Low explanatory power: it only explains policy inmobility or small changes in policy instrument, but not big policy reforms or instances of path reversal

Actor-centred institutionalism, : Veto points do not only allow private IGs (anti-WS, capture) to block policy, but also public (eg

citizens’) IGs to support government policies (pro-WS, democratic participation).

The degree of concentration of political power not only depends on formal institutions, but also on the social structure (eg active cleavages) and actors’ strategies (coalitions, internal cohesion collective action socioP power resources)

CRITICISMS