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Institutional theories. The role of political institutions

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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?
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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

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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 
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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
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The old institutionalism Types of democratic institutions in the EU
MAJORITARIAN Unidimensional party systems CONSENSUS Multidimensional party systems

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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

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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)]
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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
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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

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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
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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

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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)
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


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

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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)

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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 +
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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

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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
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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

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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.

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ITALY /SPAIN
POL. DEVOLUTION FISCAL FED. CENTR??

UK / GREECE / (PORTUGAL)

POL. DEV.?

60s

70s

80s

90s

00s

FEDERALISM & impact of DoPower
CENTRAL SHARED LOCAL
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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
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 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

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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, :


