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2005 Institutional theories. The role of political institutions Lecture 7 Health Politics Ana Rico ana.rico@medisin.uio.no The old institutionalism I. Research question Which is the impact of political institutions and the social structure on democratic politics and policy change? 2005 II. Main concepts - definitions Majority and consensus democracies, plurality and proportional electoral systems, presidentialism, parliamentarism, federalism Institutions which disperse power across political and sociopol. actors are more democratic (responsive) & equally effective Concentrated state power needed for effective policy change Political institutions in Western Europe (Liphart, 1984; 1999) Power concentration is good for passing controversial policy, but can have high political and implementation costs III. Thesis and arguments III. Anti-thesis: the new institutionalism IV. Aplications – evidence VI. Policy implications SOCIAL & POLITICAL THEORIES 1950s/60s: SOCIAL CONTEXT 1970s/1980s: ACTORCENTRED 1990s: INSTITUTIONALISM (+state-society) 2000s: ACTION THEORIES L3 L7 SOCIAL PRESSURES L2, L4 OLD INSTITUTIONALISM Formal political institutions L5 2005 SOCIAL ACTORS (IGs: dependent on social pressures) L6 POLITICAL ACTORS (STATE: independent of social pressures) L7 SOCIOP. ACTORS (STATE-SOCIETY: interdependent) NEW INSTITUTIONALISM (state institutions & state/PPs/IGs’ organization) L4, L9 L7, L9 L9 POWER-CENTRED THEORIES (interactions among collective actors & social structure) RATIONAL CHOICE (interactions among individuals ACTOR-CENTERED INSTITUTIONALISM (interactions among institutions & elites) CONCEPTS (4): The state 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 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 The old institutionalism Types of democratic institutions in the EU MAJORITARIAN Unidimensional party systems CONSENSUS Multidimensional party systems 2005 Two party systems Majority(/plurality) elections Concentration of executive power: majority government Executive dominance over parliament (Presidentialism) Unicameralism or asymm. bicameralism Unitary and centralized Unwritten constitution Representative democracy, pluralism Multiparty systems Proportional elections Executive power-sharing: coalition governements, corporatism Division of powers (Parliamentarism) Balanced bicameralism Federal and devolved Written constitution and protection of minorities Forms of direct (corporatist) democracy Lijphart, 1984 Later US research shows that Presidentialisms disperses power more The old institutionalism Other arguments and counterarguments (1) 1. • • • LIJPHART’S THESIS The interplay between social structure, political institutions and sociopolitical 2005 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 change Actor-centred institutionalism • Institutions which disperse state power allow more points of acess (veto points) for IGs to block policy The old institutionalism 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)] 2005 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 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 2005 Electoral formula District magnitude < % Prop > Small Big Yes Electoral thresholds Ballot structure > < 1/2 rounds Supplementary seats No C. The social and socioP power structure: Cleavages & pol. parties NON-PLURAL (2-3 SEMI-PLURAL (3-5 parties, 1 cleavage) parties, 1-2 cleav. Relig./linguistic homogeinity HIGH Religious/ling. heterogeinity LOW UK, Ireland New Zealand Scandinavian Australia Finland France Italy Germany Canada United States PLURAL (> 5 parties, 2-3 cleav.) Austria Israel Luxemburg Belgium Netherland Switzerland Lijphart, 1984 The DoP between Executive & Parliament PRESIDENTIALISM: President elected by citizens, strong Parliament PARLIAMENTARISM Prime Minister strong, elected by Parliament United Kingdom Canada Australia 2005 The electoral system MAJORITARIAN (plurality) United States Philippines Puerto Rico Ex-Soviet New Zealand Asia Africa PROPORTIONAL France Switzerland South America Most Western Europe Lijphart, 1994 Modern institutionalist theory I. Research questions Are institutions the main cause of policy? Do they determine actors’ behaviour? II. Main concepts - definitions 2005 Types of political institutions; path dependence and institutional inertia. 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 III. Thesis and arguments 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 Formal & informal institutions SOCIAL CONTEXT CULTURE POLICY (SUB-) SYSTEM * Ideologies * Ideas Social organiz. Associations • Churches • Firms • THE POLITICAL SYSTEM Sociopol. actors: • IGs, Prof Ass., Unions • Citizens, Mass media • Political parties 2005 a State actors: •STATE-, POL. PARTs (IGs) c * Org.Struct. * Subcultures /pol.identities Policy change b CONSTITUTION * Policy paradigms/ legacies Social groups - Communities - Ethnia, gender - Social classes Institutions: • Const. (interorg.) • Organiz. Struct. Interactions: • Coalitions/competit. • Leadership/strategy HC SYSTEM Outputs e Outcomes d f POLITY POLITICS INPUTS a. b. c. POLICY OUTPUTS Demands and supports Access to the political system Decision-making d. Institutional change e. Impact of policy f. Distribution of costs and benefits The new institutionalism Institutions (including public policies, organizations) block new policy because of their strong resistance to change (inertia) once settled (path dependence) 2005 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 Immergut, 1992 ACTOR-CENTRED INSTITUTIONALISM 1. Political institutions which allow for the dispersion of power generate multiple points of access of interest groups through which they can veto state policies 2005 DISPERSED Political institutions CONCENTRATED Weak executive (US, Switz., Fra 1) Strong executive Weak parliament and courts (EU, Fra 2) Strong parliament and courts Federal (US, Switz., Canada) PR electoral system (EU) Unitary (UK, Sweden, France) Majority electoral system (US, UK) Party discipline (EU, Canada) Corporatism (EU) 2004 Sociopolitical institutions No party discipline (USA) Pluralist (USA, UK) 2. Under dispersed formal political power, the chances of policy change (eg WS expansion) are low Immergut 1992 3. NOTE: Here Presidentialism considered to disperse rather than concentrate power (evolution from Lijphart based on legislation by decree & party discipline) Actor-centred institutionalism Determinants of National Health Insurance systems DETERMINANTS Policy idea Government’s support Interest groups Left vote & unions Territ. DoP (‘state capacity’) + Unit. Dev. (-) Unit. Centr. (+) Federal (--) SWEDEN + FRANCE + SWITZERLAND + 2005 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 Immergut, 1992 NHS (++) SHI (+) * 1st : * 2nd : + PI (-) Veto points SOCIAL CONTEXT POLICY CONTEXT Social organiz. • ASSOCIATIONS • CHURCHES • FIRMS THE POLITICAL SYSTEM 2005 Sociopol. actors: • NEW SOCIAL MOV. • MASS MEDIA • IG & PROF ASS • POLITCAL PARTIES Policy actors: a •STATE ACTORS • IG & PROF ASS • POLITCAL PARTIES c Social groups • COMMUNITIES • ETHNIA, GENDER • SOCIAL CLASSES b Policy change Outputs e Outcomes Implementation HC services Institutional framework d Interactions f POLITY POLITICS INPUTS a. b. c. POLICY OUTPUTS Demands and supports Access to the political system Decision-making d. Institutional change e. Impact of policy f. Distribution of costs and benefits Actor-centred institutionalism (State) actors and political parties are the main determinant of policy Institutions increase or decrease their opportunities to influence policy 2005 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 Maioni, 1997 CAUSES OF NHI: CANADA vs USA VARIABLES CONTEXT. Social values, culture INSTITUTIONS (RULES) 1. Executive dominance 2. Federalism 3. Party discipline ACTORS (PLAYERS) 1. State authorities 2. Pro-WS Pol. Parties + IGs Weak Access to governm. Weak No access Medium/weak Strong Yes Weak Weak No Individualism Individualism CANADA 1960S: NHI USA 1960s: NO NHI 2005 PAST POLICY 1. Past WS policies in HC (a cause of state auton. & capacity) Underdeveloped Underdeveloped Maioni, 1997 FEDERALISM IN EU HC NORDIC COUNTRIES POLITICAL DEVOLUTION FISCAL FED. CENTRAL COORD. 2005 ITALY /SPAIN POL. DEVOLUTION FISCAL FED. CENTR?? UK / GREECE / (PORTUGAL) POL. DEV.? 60s 70s 80s 90s 00s FEDERALISM & impact of DoPower CENTRAL SHARED LOCAL 2005 RESPONSIVENESS Interests represented Decision costs ++ ++ ++ ++ + + +? -- ? - ? ACCOUNTABILITY Visibility (citizens) Control (central state) Political OUTCOMES (for democratic representation) POLICY IMPLICATIONS New institutionalism, path sependence: Institutions do not change, hence once they are established big policy turns are unlikely 2005 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 CRITICISMS Old-institutionalism Presidentialism implies dispersion of power across state organizations (President and Parliament), while Parliamentarism implies dispersion of power across political parties and Igs 2005 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 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) Actor-centred institutionalism, :
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