Bert A. Rockman
This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Politics. Please check back later for the full article.
Healthcare is an essential, but often expensive, good. It is largely a linear function of a country’s wealth. Poorer countries have barebones care, primitive facilities, shortages of trained professionals, and usually very limited forms of social, or even private, insurance. Moreover, their public health systems are highly fragile and face shortages of basic sanitation facilities, potable water, and plumbing. Consequently, comparisons across systems are most meaningful when they are constrained by their level of wealth and public sanitation infrastructure. In this comparison, the United States stands as an outlier among other wealthy countries for the higher costs of its health care system and its relatively high level of inefficiency in achieving desirable health outcomes. Approximately 18% of U.S. Gross Domestic Product is spent on health care. That figure is considerably greater than the average for wealthy countries and is, indeed, the highest in the world. But that considerable input results in health outcomes that are among the worst of the wealthy countries.
Why this is so has to do with historical developments, political values, the complexity of American political institutions, and the ability of well-heeled lobbies to successfully find champions to support their grievances. It also may have a good bit to do with some factors that lie outside the health care system but interact with it. The United States is among the leaders of the highly developed world in many risk factors: obesity and the illnesses it often leads to, lethal violence especially by guns, teen age pregnancy, infant mortality, and social inequality. Most notably, however, the United States is the only country in the highly developed world that, even with the passage and partial implementation of the Affordable Care Act, lacks universal accessibility through social insurance to the health care system. The United States also is unusual for its lack of pricing regulation and pricing transparency for medical procedures.
Despite the fact that other health care systems seem to manage better with less, costs threaten to spiral in virtually all of the wealthy countries. This is because populations in all of these countries are getting older and most have a less than replacement birth rate. The demographic logic is that more people will be demanding more health care, and there will be fewer people to foot the bill. So, all systems are facing a cost crunch in the near future. While the United States is among these, thanks largely to immigration, it tends to have a more favorable ratio of donors to recipients than other rich countries.
Ultimately, all health care systems have to juggle three critical factors: (1) access to the health care system; (2) costs of the system; and (3) the quality of the system. While all of these factors seem self-evident, none actually are. They involve trade-offs. All systems ration in some way. Rationing is a buzzword among some sectors of the American political class, but all systems do it and must do it, including the American system. But they do it in different ways. Why has much to do with politics, respect for evidence, or the lack of it, and high levels of social inequality.
As a part of the policy process, implementation follows policy as formulated and decided upon. Three aspects can be distinguished as inherent to the term implementation. The first one regards the temporal order in which implementation in a policy process takes place. The second aspect concerns the causal logic, while the third one is about the form of authority. Policy implementation is looked at and talked about from two fundamentally contrasting perspectives. One can be called an “ideal” perspective, the other a realistic one. “Ideal” stands here for a use of the term implementation without further reflection; the phenomena the term refers to are taken for granted. By contrast, the alternative perspective can be labeled as a realistic one. This perspective is a construction as well, but instead of taking things for granted it invites for empirical observation and testing.
From an ideal perspective implementation is viewed as following instructions. Implementation is seen as a separate stage, identifiable as such. Inputs are supposed to determine outputs, while authority is exercised in a hierarchical relationship. From a realistic perspective implementation is seen as practice. It is approached as a multilevel phenomenon. Results of a policy process are explained by a variety of factors and social mechanisms. Authority is exercised as based on various sources. Both the view on implementation as following instructions and its realistic opposite shed a relevant light on implementation and its place in the policy process. Each view can be found in the practice as well as the study of the policy process. In the expectations about national politics the view on implementation as following instructions may be more observed than the alternative view, while at the street level of government the opposite can be supposed. However, these concern empirical questions.
As far as implementation research is concerned, the normative appeal of the assumptions underlying the view on implementation as following instructions makes that view still occurring. At the same time, these assumptions have been challenged rather fundamentally, both at a theoretical and empirical level. The opposite character of the two views has consequences for the ways implementation and its place within the policy process are understood, but also for the ways in which variation in the results of policy processes is explained. Ultimately, understanding and explaining those results are enhanced when an approach is adopted in which elements from both views have been incorporated.
Incrementalism is a model of the policy process advanced by Charles Lindblom, who views rational decision-making as impossible for most issues due to a combination of disagreement over objectives and inadequate knowledge base. Policies are made instead through a pluralistic process of partisan mutual adjustment in which a multiplicity of participants focus on proposals differing only incrementally from the status quo. Significant policy change occurs, if at all, through a gradual accumulation of small changes, a process Lindblom calls seriality. For incrementalism to yield defensible policy outcomes, three conditions must be satisfied, all of which are far from automatic: 1) all, or at least most, social interests must be represented; 2) political resources must be balanced sufficiently among groups that no one actor or coalition dominates; and 3) political parties must be moderate and pragmatic, permitting a convergence to an ever-evolving political center.
While Lindblom sees nonincremental policy departures as extremely rare, subsequent research suggests that major policy departures may occur in response to crises or mass public arousal, through the development of a rationalizing breakthrough after many years of experience with policy implementation, or through a process of punctuated equilibrium. While many scholars and policymakers have argued that policymaking can and should be more rational, or that nonincremental alternatives may at times be superior to incremental ones, implementing nonincremental policy departures poses special problems and often gives way to incrementalism in the administrative process as public attention and support for strong action wanes. Nonincremental policy departures are more likely to be both enduring and effective where long experience with an issue leads to consensus on values and an adequate knowledge base, giving rise to a rationalizing breakthrough.
Classic accounts of the relationship between leadership and public administration used to be straightforward: Political officials exercise leadership in terms of providing direction to government, and administrations implement decisions made by those leaders. Over the past decades, however, both scholarly notions and empirical manifestations of leadership and administration have undergone substantive change. While the political leadership literature continues to be more interested in such aspects as goal identification and definition, and the ways and means by which leaders manage to garner and maintain support for their agendas, the crucial importance of implementation in terms of leadership effectiveness has been explicitly acknowledged since the seminal work of James MacGregor Burns who famously defined leadership as “real, intended social change.” Conversely, public administration scholars have discovered the role of bureaucrats in the leadership process as important subfields of public administration.
To some considerable extent, these reorientations in the political study of leadership and administration have been driven by empirical developments in the real world of leaders and administrators. In many of the established democracies, political leaders have come to realize the importance of administrative resources, and in some contexts, such as in the United States, it seems justified to speak of particular administration-centered approaches to, and strategies of, executive leadership. At the same time, large-scale reforms of the public sector have fundamentally altered the role of bureaucrats in the leadership process. While individual top civil servants, especially (but not only) in Westminster systems, have always exercised some leadership, New Public Management reforms designed to increase the efficiency of the public sector extended leadership roles across the bureaucracy. The relationship between political leaders and bureaucrats continues to display major differences between countries, yet politicization of the civil service in its various forms marks a strong cross-national trend. In some countries, the proliferation of special advisers stands out as a more specific element of change with important implications for the evolving nature of executive leadership.
Such differences between countries notwithstanding, a broad empirical inquiry suggests that the developments in the political and administrative parts of the executive branch in many major democracies are marked by divergent dynamics: While there is a notable trend within the political core executive to centralize power with the chief executive (prominently referred to as “presidentialization” by some authors), the public bureaucracy of many developed countries has experienced a continuous dispersion of leadership roles. The implications of these ongoing changes have remained understudied and deserve further scholarly attention. However, alongside a host of conceptual and methodological issues, perhaps the most difficult and complex challenges to leadership and administration, both for political science and politics itself, relate to processes of internationalization and globalization.
Annelise Russell, Maraam Dwidar, and Bryan D. Jones
Scholars across politics and communication have wrangled with questions aimed at better understanding issue salience and attention. For media scholars, they found that mass attention across issues was a function the news media’s power to set the nation’s agenda by focusing attention on a few key public issues. Policy scholars often ignored the media’s role in their effort to understand how and why issues make it onto a limited political agenda. What we have is two disparate definitions describing, on the one hand, media effects on individuals’ issue priorities, and on the other, how the dynamics of attention perpetuate across the political system. We are left with two notions of agenda setting developed independently of one another to describe media and political systems that are anything but independent of one another.
The collective effects of the media on our formal institutions and the mass public are ripe for further, collaborative research. Communications scholars have long understood the agenda setting potential of the news media, but have neglected to extend that understanding beyond its effects on mass public. The link between public opinion and policy is “awesome” and scholarship would benefit from exploring the implications for policy, media, and public opinion.
Both policy and communication studies would benefit from a broadened perspective of media influence. Political communication should consider the role of the mass media beyond just the formation of public opinion. The media as an institution is not effectively captured in a linear model of information signaling because the public agenda cannot be complete without an understanding of the policymaking agenda and the role of political elites. And policy scholars can no longer describe policy process without considering the media as a source of disproportionate allocation of attention and information. The positive and negative feedback cycles that spark or stabilize the political system are intimately connected to policy frames and signals produced by the media.
Anthony R. Zito
New policy instruments have come onto the policy agenda since the 1970s, but there is a real question as to whether the ideas behind the design of such tools are actually all that “new” when you assess the role of the policy instrument in its particular institutional and policy context. Taking Hood’s 1983 categorization of instruments as tools that manipulate society to achieve public goals via nodality (information), authority, treasure (finance), or organization, we can find instances where innovations in these areas pre-date the 1970s. Nevertheless, the mention of these instruments in international organizations such as the Organization for Economic Cooperation and Development (OECD) and national institutions and debates as the means for both improving governance and protecting economic efficiency have increased in light of a number of interacting trends: the rise of neo-liberal and new management ideologies, the increasing perception of a number of wicked problems (e.g., climate change) and nested, politically sensitive problems (e.g., health and welfare policy), a rethinking of the role of the state, and other reasons. A typology is offered for differentiating changes and innovation in policy instruments. There have been some very notable and complex policy instruments that have reshaped politics and public policy in a particular policy sector: a notable example of this is emissions trading systems, which create market conditions to reduce emissions of climate change gases and other by-products. Information and financial instruments have become more prominent as tools used to achieve policy aims by the state, but equally significant is the fact that, in some cases, it is the societal actors themselves that are organizing and supporting the management of an instrument voluntarily. However, this obscures the fact that a much more significant evolution of policy instruments has come in the area that is associated with traditional governing, namely regulation. The reality of this “command and control” instrument is that many historical situations have witnessed a more flexible relationship between the regulator and the regulated than the term suggests. Nevertheless, many OECD political systems have seen a move towards “smart” or flexible regulation. In promoting this new understanding of regulation, it is increasingly important to see regulation as being supplemented by, supported by, and sometimes reinforcing new policy instruments. It is the integration of these “newer” policy instruments into the regulatory framework that represents perhaps the most significant change. Nevertheless, there is some reason to question the real impact new policy instruments have in terms of effectiveness and democratic legitimacy.
This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Politics. Please check back later for the full article.
The New Political Governance (NPG)—or alternatively the New Public Governance—is best understood as a heuristic model that allows us to empirically consider, compare, and contrast the evolution of democratic governance and public administration beyond the reforms associated with New Public Management. Contributors have focused on NPG as both a product of and a response to the challenges of a complex, pluralist state. Key pressures said to spur NPG include aggressive, 24/7 media; greater demands for transparency; an expansion in government oversight and accountability; an expansion of the advocacy industry; and, an increasingly polarized and volatile electorate. While these pressures are not, unto themselves, new, what is new is the response to them. Four primary elements characterize NPG as a response to these forces: the onset of the permanent campaign; full, or nearly full, integration of the range of activities associated with governing with constant concerns and tactics historically associated with campaigning; the expansion and elevation of the role of partisan political staff; politicization through the personalization of appointments to senior public service positions; and the shift in norms from a neutral, non-partisan public service to an expectation of promiscuous partisanship that demands enthusiasm for the agenda of the government of the day.
The NPG framework has not been without criticism. Theoretically, some have argued for greater precision in the core concepts of NPG (e.g., politicization). Others have questioned whether it is so much the behaviors themselves—expected or undertaken—or the more public context in which they occur that marks the real shift. Finally some have pointed out the lack of integration of exogenous influences in the NPG model. A number of commenters have pointed out the limited empirical evidence that has been provided to support the NPG model.
Johabed G. Olvera and Claudia N. Avellaneda
As one of the reforms supported by the New Public Management movement, Performance Management Systems (PMSs) have been implemented worldwide, across various policy areas and different levels of government. PMSs require public organizations to establish clear goals, measure indicators of these purposes, report this information, and, ultimately, link this information with strategic decisions aimed at improving agencies’ performances. Therefore, the components of any PMS include: (1) strategic planning; (2) data collection and analysis (performance measurement); and (3) data utilization for decision-making (performance management). However, the degree of adoption and implementation of PMS components varies across both countries and levels of government. Therefore, in understanding the role of PMSs in public administration, it is important to recognize that the drivers explaining the adoption of PMS components may differ from those explaining their implementation. Although the goal of any PMS is to boost government performance, the existent empirical evidence assessing PMS impact on organizational performance reports mixed results, and suggests that the implementation of PMSs may generate some unintended consequences. Moreover, while worldwide there is a steady increase in the adoption of performance metrics, the same cannot be said about the use of these metrics in decision-making or performance management. Research on the drivers of adoption and implementation of PMSs in developing countries is still lacking.
Michael Mintrom and Joannah Luetjens
In recent years, significant effort has been applied to understanding and empirically testing the concept of policy entrepreneurship in a range of different settings. Despite these efforts, studies to date have tended to focus on policy entrepreneurs in domestic policy settings. Few have articulated the potential role that policy entrepreneurs play in understanding foreign policy decision-making. Coupled with theories and evidence from the field of foreign policy analysis, the concept of policy entrepreneurship lends itself to analyzing how actors in the foreign policy space draw attention to problems, advance workable proposals, and link outcomes to symbolic values. This article introduces and applies a framework for the analysis of policy entrepreneurs seeking to influence foreign policy decision-making. This framework is then used to underpin illustrative case studies of foreign policy entrepreneurs. The variety of recent scholarly contributions regarding policy entrepreneurs and foreign policy suggests that many more opportunities exist for such work to be conducted in the future. This is an exciting prospect. Valuable, generalizable insights are more likely to emerge from such a collective research enterprise if the various individual contributions are informed by greater conceptual coherence.
We frequently employ analogies such as a leaking roof or finishing last in a ranking to illustrate that there is a serious problem requiring attention. Unfortunately, policy realities are far more complex and less obvious since policymakers do not benefit from objective measures or clear signals akin to having water dripping over their head to indicate the presence of a problem. In fact, they face a plethora of policy actors constantly engaged in defining policy problems for them based on competing frames of references.
The term “policy problems” evokes questions of what makes a social issue a policy problem, but it also raises questions regarding whether problems can actually be solved via a public response and how. Policy problems occupy a crucial role in policy studies, if not for the simple reason that political authorities are unlikely to alter or create policies without the presence of problems. As such, policy problems occupy an important place in popular theoretical frameworks frequently employed in the field of public policy. The formulation of policy problems is at the heart of the punctuated-equilibrium theory since these can result in the creation of new political coalitions seeking transformative policy change. In the social construction of target populations approach, the ways in which the public perceives particular subgroups or subpopulations dictate our understanding of policy problems and the types of instruments to deploy. Frameworks for policy feedback assume that current policies structure the formulation of policy problems along the lines of altering existing policies. In the multiple-streams theoretical framework, policy problems are part of a toolkit used to validate the use of already made solutions by policy entrepreneurs seeking the right opportunity for implementation.
A thorough treatment and analysis of policy problems exist within the policy design literature. Scholars operating within this tradition have emphasized the individual characteristics of policy problems and, as importantly, how these matter when it is time to enact solutions. Characteristics of problems, such as causality and severity, are key elements in the identification and formulation of policy problems and their likelihood to feature prominently in the policy agenda of governmental actors. Additional elements, such as the divisibility of policy problems and the extent to which these problems can be monetarized, matter in assessing the possibility of enacting solutions.
This raises the fundamental question of whether policy problems can actually be resolved. Mature policies are the norm in industrialized countries, and these are increasingly subject to international agreements. Consequently, there are, for example, many more interdependencies, which have led to the reemergence of wicked-problems analyses. However, a substantial number of contributions have associated complexity with wicked problems, raising questions surrounding their intrinsic qualities and the danger of conceptual stretching.