Chapter 6: Policy conflicts: the case of healthcare
Despite what is assumed in much of the economic literature, an exception being institutional economics, policies are not fully plastic and cannot be sufficiently tailored in order to regulate a practice in all its manifestations or relevant aspects. Policy conflicts result from this. In this chapter we discuss conflicts between instituted policies regulating a practice, rather than conflicts between groups, or classes, of individuals who have an interest in particular policies taking a particular shape. We recognize these are significant, but distinct, dimensions that have received extensive attention in the literature. However, we wish to identify and investigate further the recognized, but under-emphasized aspect of ‘practice’. We argue this complements the class and group based conflict analysis, and represents a further dimension of potential conflict. In this chapter we identify five distinctive sources of policy conflict. We discuss two particular sources of policy conflict in particular, emphasizing historical contingency and emergence of institutions in the specific setting of market oriented reform in healthcare as a means of indicating that the policy conflicts are real and can have substantial influence on activities in this practice. In many countries around the world elements of market orientation are introduced or extended into healthcare. The consequences of the policies may not be as expected as a result of policy conflicts, and may not be uniformly beneficial as a consequence.
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