Bargaining Power : Health Policymaking From England and New Zealand

This monograph applies Kingdon's Multiple Streams Framework to two policymaking episodes of implementing pay for performance in general practice, conducted in England and New Zealand. The Framework's explanatory power for policymaking in Westminster majoritarian jurisdictions is tested and, based on rigorous comparative analysis, recommendations are made for its refinement. The monograph also offers striking lessons for policymakers about how to negotiate successfully with general practitioners. .-- Provided by publisher Foreword 5 Preface and Acknowledgements 8 Contents 10 Acronyms 12 List of Tables 13 Chapter 1: A Tale of Two Countries 14 The Setting 16 History of Approaches to Health Policy Problems 17 The Policy Instrument: Pay-for-Performance 18 References 19 Chapter 2: Analysing Public Policy: Does Kingdon’s Multiple Streams Framework Help? 22 Ambiguity, Fluid Participation and Unclear Technology 23 Problems Stream 25 Politics Stream 25 Policy Stream 26 Policy Windows 26 Policy Entrepreneurs 27 Improving the MS Framework 27 References 32 Chapter 3: A Comparison of the English and New Zealand General Practice Sub-Systems 34 The English Story 35 The New Zealand Story 36 Key Differences 38 Shared History of New Public Management-Based Health Reforms During 1990s 39 References 42 Chapter 4: England: Context and the Quality and Outcomes Framework 45 Background 45 The NHS Plan 2000 46 A Challenge to Centralism 47 Who Was Involved 48 What Was Done 50 How It Was Done 53 Implementation 55 Barriers and Enablers of the Policymaking Process 56 Redistribution of General Practice Resources 56 Balancing Funder Interests and Clinical Autonomy 58 Shaping Patterns of Interaction Between the State and Interest Groups 58 Solving the Technical Challenges 61 Choice of Indicators 61 Obtaining Access to Data 62 Testing the Model 64 Evaluations and Reviews of the Scheme 66 References 68 Chapter 5: Utility of Kingdon’s Framework: Policymaking in England 70 Non-incremental Change in Conditions of Ambiguity, Fluid Participation and Unclear Technology? 71 Problems Stream 72 Politics Stream 73 Policy Stream 74 Policy Window 77 Policy Entrepreneurs 78 Entrepreneurial Risk-Taking 80 Explanatory Comprehensiveness of Kingdon’s MS Framework 80 Other Drivers of Policymaking Processes 81 The Importance of Historical Antecedents 81 Institutional and Structural Features 82 Importance of Rational Choice Drivers 83 Does the Zahariadis Model Encourage Consideration of These Factors? 84 References 85 Chapter 6: New Zealand: Context and the Performance Programme 86 Background 86 A Ministerial/Civil Service Partnership 92 The Government Strategies 93 Who Was Involved 95 How It Was Done 102 Implementation 106 Barriers and Enablers of the Policymaking Process 107 Redistribution of General Practice Resources 107 Balancing Funder Interests and Clinical Autonomy 109 Shaping Patterns of Interaction Between the State and Interest Groups 110 Solving the Technical Challenges 113 Choice of Indicators 113 Obtaining Access to Data 113 Testing the Model 114 Evaluations and Reviews of the PP 115 Impact on Ambulatory-Sensitive Admissions 117 Review of Performance and Incentive Framework 118 References 118 Chapter 7: Utility of Kingdon’s Framework: Policymaking in New Zealand 121 Non incremental Change in Conditions of Ambiguity, Fluid Participation and Unclear Technology? 122 Problems Stream 123 Politics Stream 124 Policy Stream 124 Policy Window 126 Policy Entrepreneurs 126 Motivation of Entrepreneurs 127 Explanatory Comprehensiveness of Kingdon’s MS Framework 128 Other Drivers of Policymaking Processes 129 Institutional Features 129 Heterogeneity of the Institutional Landscape 131 Historical Antecedents 132 Does the Zahariadis Model Encourage Consideration of These Factors? 132 References 133 Chapter 8: The Two Case Studies Compared 134 What Outcomes Were Achieved by These Policymaking Processes? 137 Administrative Outcomes 137 Health Outcomes 140 The Strength of the Comparative Case 140 Similarities Which Are Relevant to the Case Studies 141 Differences Relevant to the Case Studies 142 Utility of MS Framework 143 Incremental or Non-incremental Change? 143 Ambiguity, Fluidity and Unclear Technology? 144 Importance of Policy Entrepreneurs 144 Poor Fit with Westminster Jurisdictions 145 Identifying Other Drivers of Policy Variation and Change 146 Opportunity for Bargaining and Negotiation 146 England 146 New Zealand 147 What Theories Best Explain This Evidence? 148 Implications for Kingdon’s MS Framework 151 Enhancing the MS Framework 152 Summing Up: Research Findings and Looking Forward 154 Other Comparative Cases 156 References 158 Chapter 9: Conclusion 161 Reference 163 Appendix 164 Methods 164 Limitations 166 References 167 Index 176 Front Matter ....Pages i-xv A Tale of Two Countries (Verna Smith)....Pages 1-8 Analysing Public Policy: Does Kingdon’s Multiple Streams Framework Help? (Verna Smith)....Pages 9-20 A Comparison of the English and New Zealand General Practice Sub-Systems (Verna Smith)....Pages 21-31 England: Context and the Quality and Outcomes Framework (Verna Smith)....Pages 33-57 Utility of Kingdon’s Framework: Policymaking in England (Verna Smith)....Pages 59-74 New Zealand: Context and the Performance Programme (Verna Smith)....Pages 75-109 Utility of Kingdon’s Framework: Policymaking in New Zealand (Verna Smith)....Pages 111-123 The Two Case Studies Compared (Verna Smith)....Pages 125-151 Conclusion (Verna Smith)....Pages 153-155 Back Matter ....Pages 157-179 Annotation This monograph applies Kingdon's Multiple Streams Framework to two policymaking episodes of implementing pay for performance in general practice, conducted in England and New Zealand. The Framework's explanatory power for policymaking in Westminster majoritarian jurisdictions is tested and, based on rigorous comparative analysis, recommendations are made for its refinement. The monograph also offers striking lessons for policymakers about how to negotiate successfully with general practitioners