Explaining cross-regional policy variation in public sector reform: Institutions and change actors in the health sector in Spain
| Published date | 01 January 2017 |
| Date | 01 January 2017 |
| Author | Nicolás Barbieri,Sheila González,Raquel Gallego |
| DOI | 10.1177/0952076716637897 |
| Subject Matter | Articles |
Public Policy and Administration
2017, Vol. 32(1) 24–44
!The Author(s) 2016
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DOI: 10.1177/0952076716637897
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Article
Explaining cross-regional
policy variation in public
sector reform:
Institutions and change
actors in the health
sector in Spain
Raquel Gallego, Nicola
´s Barbieri and
Sheila Gonza
´lez
Universitat Auto
`noma de Barcelona, Spain
Abstract
How can we explain cross-regional policy variation? That is, how can we understand
different policy outcomes within similar institutional and organizational settings?
Scholars have recently reflected on the new institutionalist explanatory pitfall involved
in assuming a causality link between institutional factors and policy outcomes and argue
that such link needs to rely on evidence from policy variables. On this line, recent
contributions have built a causal model that links types of institutional change to
types of actors’ roles and strategies, within particular contextual and organizational
scenarios that favor or hinder their emergence. This paper pursues this explanatory
interest by applying this model to the analysis of how decision-making by two regional
governments in Spain has led to different institutional and policy change outcomes in the
same policy sector, namely, public management reform in healthcare. This study con-
firms the explanatory relevance of the model’s key variables, but provides evidence of
how some of them may be reinterpreted to provide a dynamic explanation of their
influence on the process and outcome of institutional and policy change.
Keywords
Health policy, new institutionalism, policy variation, public management, Spain
Corresponding author:
Raquel Gallego, Institut de Govern i Polı
´tiques Pu
´bliques, Edifici MRA, 1
a
Planta, Universitat Auto
`noma de
Barcelona, 08193 Bellaterra, Spain.
Email: raquel.gallego@uab.cat
Introduction
Comparative politics and public policy research share an interest about the politics
of institutional and policy change. This interest has translated into different
research issues, such as patterns of policy variation in the content of reform policies
and the role of particular factors in explaining policy variation across territories.
A case in point is the study of public sector reform, with a special focus on the
public management policy domain (Barzelay, 2001; Barzelay and Gallego, 2006,
2010a, 2010b; Ferlie and Ongaro, 2015; Hood, 2000; Knill, 1999; Ongaro, 2008,
2009; Pollitt and Bouckaert, 2000; Sahlin-Andersson, 2002). This literature has
largely benefited from the use of new institutionalist approaches in order to explain
variation in institutional and policy change in a policy domain where redesigning
institutions involves changing policy, namely, public management.
However, these research developments suggest at least two challenges. First, as
Radaelli et al. (2012) have recently put forward, there is an explanatory pitfall
involved in assuming a causality link between institutional factors and policy out-
comes just because they appear repeatedly associated. They argue that such a
missing explanation link needs to rely on evidence from policy variables, such as
resource distribution among public and private actors in that particular policy
sector, network relations among them, or actors’ prevailing discourses and norma-
tive assumptions.
Second, we need to improve our understanding of incremental institutional and
policy change, because a substantial part of change processes occur that way. New
institutionalism relies on assumptions that reinforce the idea of stability and are ill
suited for explaining change. Change is explained not as an incremental, endogen-
ous process, but as an abrupt shock fostered by external factors. Recent contri-
butions provide useful theoretical tools that could help advance on these lines.
Hacker (2004) and Streeck and Thelen’s (2005) elaborated typologies of institu-
tional change that, despite some variations, were based on the identification of
external and internal barriers to change. Despite being useful for analytical pur-
poses, this sort of contribution only provides help for classification of empirical
examples of institutional change. As Radaelli et al. (2012) highlight, there could be
an explanatory pitfall if we attributed causal arguments in the use of typologies.
In this sense, Mahoney and Thelen (2010) develop a theoretical model that tries
to build causality arguments by linking contextual and organizational properties
(which partly fit Radaelli et al.’s policy variables) to types of institutional change
expected. They define a combination of variables—characteristics of the political
context, characteristics of targeted institutions, and typology of actors and their
strategies. They argue that particular contextual and institutional features facilitate
the emergence of particular types of agents—with their associated type of strate-
gies—in the pursuit of particular types of institutional change. This logic has been
applied to numerous empirical analyses, providing insights in the explanation of
incremental institutional change (Falleti, 2010; Gonza
´lez, 2013; Jacobs, 2010;
Kwamena, 2010; Marshall, 2014; Sheingate, 2010; Slater, 2010).
Gallego et al. 25
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