Institutional theories. The role of political institutions Lecture 7

1. Institutional theories.The role of political institutionsLecture 7 Health Politics Ana Rico ana.rico@medisin.uio.no

2. The old institutionalism I. Research question • Which is the impact of political institutions and the social structure on democratic politics and policy change? II. Main concepts - definitions • Majority and consensus democracies, plurality and proportional electoral systems, presidentialism, parliamentarism, federalism III. Thesis and arguments • Institutions which disperse power across political and sociopol. actors are more democratic (responsive) & equally effective III. Anti-thesis: the new institutionalism • Concentrated state power needed for effective policy change IV. Aplications – evidence • Political institutions in Western Europe (Liphart, 1984; 1999) VI. Policy implications Power concentration is good for passing controversial policy, but can have high political and implementation costs

3. SOCIAL & POLITICAL THEORIES L7 L3 1950s/60s: SOCIAL CONTEXT OLD INSTITUTIONALISM Formal political institutions SOCIAL PRESSURES L2, L4 SOCIAL ACTORS (IGs: dependent on social pressures) L5 POLITICAL ACTORS (STATE: independent of social pressures) 1970s/1980s: ACTOR-CENTRED L6 SOCIOP. ACTORS (STATE-SOCIETY: interdependent) 1990s: INSTITUT-IONALISM (+state-society) L7 NEW INSTITUTIONALISM (state institutions & state/PPs/IGs’ organization) L9 L4, L9 L7, L9 2000s: ACTION THEORIES POWER-CENTRED THEORIES (interactions among collective actors & social structure) RATIONAL CHOICE (interactions among individuals ACTOR-CENTERED INSTITUTIONALISM (interactions among institutions & elites)

4. 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

5. 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

6. The old institutionalism • Types of democratic institutions in the EU Lijphart, 1984 Later US research shows that Presidentialisms disperses power more

7. The old institutionalism • Other arguments and counterarguments (1) • LIJPHART’S THESIS • The interplay between social structure, political institutions and sociopolitical 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

8. 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)] • 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

9. 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 MajProp MajProp • Electoral formula < % Prop > Electoral thresholds > < • District magnitude Small Big Ballot structure 1/2 rounds • Supplementary seats No Yes • C. The social and socioP power structure: Cleavages & pol. parties Lijphart, 1984

10. The DoP between Executive & Parliament The electoral system Lijphart, 1994

11. Moderninstitutionalist theory I. Research questions • Are institutions the main cause of policy? Do they determine actors’ behaviour? II. Main concepts - definitions • Types of political institutions; path dependence and institutional inertia. III. Thesis and arguments • 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 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

12. POLITY POLITICS POLICY Formal & informal institutions SOCIALCONTEXT CULTURE POLICY (SUB-) SYSTEM • Social organiz. • Associations • Churches • Firms THE POLITICAL SYSTEM * Ideologies * Ideas • Sociopol. actors: • IGs, Prof Ass., Unions • Citizens, Mass media • Political parties c Policy change a • State actors: • STATE-, POL. PARTs (IGs) * Org.Struct. * Policy paradigms/ legacies * Subcultures /pol.identities b CONSTITUTION HC SYSTEM Social groups - Communities - Ethnia, gender - Social classes • Interactions: • Coalitions/competit. • Leadership/strategy • Institutions: • Const. (interorg.) • Organiz. Struct. Outputs e d f Outcomes OUTPUTS INPUTS • Demands and supports • Access to the political system • Decision-making d. Institutional change e. Impact of policy f. Distribution of costs and benefits

13. The new institutionalism • Institutions (including public policies, organizations) block new policy because of their strong resistance to change (inertia) once settled (path dependence) • 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

14. Immergut, 1992

15. Actor-centred institutionalism Determinants of National Health Insurance systems Immergut, 1992

16. POLITY POLITICS POLICY Veto points SOCIALCONTEXT POLICYCONTEXT • Social organiz. • ASSOCIATIONS • CHURCHES • FIRMS THE POLITICAL SYSTEM • Sociopol. actors: • NEW SOCIAL MOV. • MASS MEDIA • IG & PROF ASS • POLITCAL PARTIES • Policy actors: • STATE ACTORS • IG & PROF ASS • POLITCAL PARTIES a c Policy change Implemen- tation • Social groups • COMMUNITIES • ETHNIA, GENDER • SOCIAL CLASSES b Institutional framework HC services Interactions Outputs d e f Outcomes OUTPUTS INPUTS • Demands and supports • Access to the political system • Decision-making d. Institutional change e. Impact of policy f. Distribution of costs and benefits

17. Actor-centred institutionalism • (State) actors and political parties are the main determinant of policy • Institutions increase or decrease their opportunities to influence policy 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

18. CAUSES OF NHI: CANADA vs USA Maioni, 1997

19. FEDERALISM IN EU HC NORDIC COUNTRIES FISCAL FED. CENTRAL COORD. POLITICAL DEVOLUTION ITALY /SPAIN FISCAL FED. CENTR?? POL. DEVOLUTION POL. DEV.? UK / GREECE / (PORTUGAL) 60s 70s 80s 90s 00s

20. FEDERALISM & impact of DoPower Political OUTCOMES (for democratic representation)

21. POLICY IMPLICATIONS • New institutionalism, path sependence: • Institutions do not change, hence once they are established big policy turns are unlikely • 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

22. 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 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 Actor-centred institutionalism, : • 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)