TY - JOUR
T1 - Self-undermining policy feedback and the creation of National Health Insurance in Ghana
AU - Wireko, Ishmael
AU - Béland, Daniel
AU - Kpessa-Whyte, Michael
N1 - Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Contributing to the ongoing debate about policy feedback in comparative public policy research, this article examines the evolution of healthcare financing policy in Ghana. More specifically, this article investigates the shift in healthcare financing from full cost recovery, known as 'cash-and-carry', to a nation-wide public health insurance policy called the National Health Insurance Scheme (NHIS). It argues that unintended, self-undermining feedback effects from the existing health policy constrained the menu of options available to reformers, while simultaneously opening a window of opportunity for transformative policy change. The study advances the current public policy scholarship by showing how the interaction between policy feedbacks and other factors-particularly ideas and electoral pressures-can bring about path-departing policy change. Given the dearth of scholarship on self-undermining policy feedback effects in the Global South, this contribution's originality lies in its application of the novel theory to the sub-Saharan African context.
AB - Contributing to the ongoing debate about policy feedback in comparative public policy research, this article examines the evolution of healthcare financing policy in Ghana. More specifically, this article investigates the shift in healthcare financing from full cost recovery, known as 'cash-and-carry', to a nation-wide public health insurance policy called the National Health Insurance Scheme (NHIS). It argues that unintended, self-undermining feedback effects from the existing health policy constrained the menu of options available to reformers, while simultaneously opening a window of opportunity for transformative policy change. The study advances the current public policy scholarship by showing how the interaction between policy feedbacks and other factors-particularly ideas and electoral pressures-can bring about path-departing policy change. Given the dearth of scholarship on self-undermining policy feedback effects in the Global South, this contribution's originality lies in its application of the novel theory to the sub-Saharan African context.
KW - Ghana
KW - Health care
KW - National Health Insurance Scheme
KW - health insurance
KW - policy change
KW - policy feedback
UR - http://www.scopus.com/inward/record.url?scp=85100125823&partnerID=8YFLogxK
U2 - 10.1093/heapol/czaa080
DO - 10.1093/heapol/czaa080
M3 - Article
C2 - 32989440
AN - SCOPUS:85100125823
SN - 0268-1080
VL - 35
SP - 1150
EP - 1158
JO - Health Policy and Planning
JF - Health Policy and Planning
IS - 9
ER -