Policy styles in healthcare: Understanding variations in health systems

In this chapter we seek to better understand how health systems are structured by revisiting the concept of policy styles. We develop two arguments. First, health systems are organised and structured to advance three principal goals: pooling of financial risks, delivering services, and paying for healthcare. This brings together a finite set of actors, ideas and instruments that are involved in pursuing these goals, which in turn shapes long-term policy dynamics and processes within the sector. Thus, a sectoral health policy style is intricately linked with the need to satisfy functional pre-requisites of the sector. Second, similar to national policy styles countries can also display distinctive sectoral health policy styles. Using Cashore and Howletts policy elements framework, this variation can be understood at the macro level in terms of ideas, actors, implementation preferences, at the meso level in terms of policy instruments, and the micro level in terms of characteristics of policy change. Here we see that sectoral styles vary at the macro and meso levels, but show remarkable similarity at the micro level.