Summary and conclusions
Troy Media – by Ted Marmor
The last decades have seen a growing body of comparative study in health policy, but this growth was not matched by a growing understanding of the processes of policy learning from the experiences of other countries.
There is, in fact, little attention paid to methodological questions of this learning process.
The confluence of economic, demographic and ideological factors that led to extensive debate about the future of the welfare state also created pressure to reform health care systems. Fiscal strains and declining political support for an active role of the state undermined support for welfare state expansion and that strain also affected health policy.
There was, indeed, growing pressure to seek new policy solutions abroad. That pressure also gave rise to a new body of research within national research communities as well as international agencies like the World Bank, OECD, WHO and EU. However, to date most of that research consists of merely descriptive studies of health care systems and policy measures within national boundaries.
The studies pay little attention to the question of what experiences can be applied in another country and under what circumstances.
Institutional and cultural factors are important elements in the policy context as determinants of successful reception and implementation of ideas.
In practice, there is much mislearning and misrepresentation by omission. Policy makers and politicians feel pressured to change, but have little or no time (or willingness) to critically assess claims about policy experience across the border.
Potentially, comparison can bring learning opportunities as other countries can serve as natural experiments, in particular when the policy contexts are similar. Some lessons apply across many countries. Similar pressure can create opportunities for learning, and international organizations serve as platforms for debate and potential sources for comparative studies.
Existing studies largely ignore the important difference between the process of learning about other countries’ experiences, learning why certain change takes place, and the process of drawing lessons from that experience. But the basic ingredients for improved policy learning are there: the statistical database, the first generation of descriptive country studies and the experience of academics and international organizations.