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Explaining system-level change in welfare governance: the role of policy indeterminacy and concatenations of social mechanisms

Published online by Cambridge University Press:  07 December 2020

Edoardo Ongaro Open the ORCID record for Edoardo Ongaro [Opens in a new window]  and
Francesco Longo
Edoardo Ongaro*
Affiliation:
Open University, UK – Faculty of Business and Law, Milton Keynes, UK
Francesco Longo
Affiliation:
Bocconi University – Department of Social and Political Sciences, via Roentgen, 1 – 20136Milano, Italy
*
*Corresponding author. Email: edoardo.ongaro@open.ac.uk
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Abstract

This paper argues that a certain level of indeterminacy in policy design may be a factor facilitating rather than hindering system-level change in welfare governance arrangements, provided it is combined with the triggering of specific concatenations of social mechanisms shaping the dynamics of the change process. The argument is illustrated by an analysis of a case of systemic change in chronic disease management occurred in the Italian region of Lombardy over 2016–2017, when a radically novel governance of chronic disease for the 10 million population was put in place (a health care system that was later tested to its limits by the COVID-19 pandemic outburst which reached dramatic intensity in this region). This represented a major change in a key area of social and health policy. We claim that such change processes may be studied by means of the conceptual tools of social mechanisms. The analysis of social mechanisms represents a lively research agenda for explaining change in public governance and public policy.

Keywords

Chronic careLombardy health care systemsocial mechanismssystem-level changewelfare governance
Type
Article
Information
Health Economics, Policy and Law , Volume 16 , Issue 3 , July 2021 , pp. 340 - 354
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

Asquer, A (2012) Managing the process of decentralization: transforming old public entities into new agencies in the agricultural sector. International Public Management Journal 15, 207–229.CrossRefGoogle Scholar
Barzelay, M (2003) Introduction: the process dynamics of public management policymaking. International Public Management Journal 6, 251–282.Google Scholar
Barzelay, M and Campbell, C (2003) Preparing for the Future: Strategic Management in Government. Washington, DC: The Brookings Institutions.Google Scholar
Barzelay, M and Gallego, R (2006) From ‘new institutionalism’ to ‘institutional processualism’: advancing knowledge about public management policy change. Governance 19, 531–557.CrossRefGoogle Scholar
Barzelay, M and Gallego, R (2010) The comparative historical analysis of public management policy cycles in France, Italy, and Spain: symposium introduction. Governance 23, 209–223.Google Scholar
Bates, DW, Saria, S, Ohno-Machado, L, Shah, A and Escobar, G (2014) Big data in health care: using analytics to identify and manage high-risk and high-cost patients. Health Affairs 33, 1123–1131.CrossRefGoogle ScholarPubMed
Boudon, R (1991) What middle-range theories are. Contemporary Sociology 20, 519–522.CrossRefGoogle Scholar
Capano, G, Howlett, M, Ramesh, M and Virani, A (eds) (2019) Making Policies Work: First and Second Order Mechanisms in Policy Design. Cheltenham, UK and Northampton, MA: Edward Elgar.CrossRefGoogle Scholar
Capano, G, Howlett, M and Ramesh, M (guest editors) (forthcoming) A mechanistic approach to public policy: improving policy design by better understanding policy mechanisms. Public Policy and Administration.Google Scholar
CERGAS (2017) Rapporto OASI. Milan: Egea.Google Scholar
Eisenhardt, KM (1989) Building theories from case study research. Academy of Management Review 14, 532–550.CrossRefGoogle Scholar
Elster, J (1989) Nuts and Bolts for the Social Sciences. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Elster, J (1993) Political Psychology. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Elster, J (1998) A plea for mechanisms. In Hedstrom, P and Swedberg, R (eds), Social Mechanisms: An Analytical Approach to Social Theory. Cambridge: Cambridge University Press, pp. 45–73.CrossRefGoogle Scholar
Gambetta, D (1998) Concatenations of mechanisms. In Hedstrom, P and Swedberg, R (eds), Social Mechanisms: An Analytical Approach to Social Theory. Cambridge: Cambridge University Press, pp. 102–124.Google Scholar
Hedstrom, P (2005) Dissecting the Social: On the Principles of Analytical Sociology. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Hedstrom, P and Swedberg, R (eds) (1998) Social Mechanisms: An Analytical Approach to Social Theory. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Longo, F (2016) Lessons from the Italian NHS retrenchment policy. Health Policy 120, 306–315.CrossRefGoogle ScholarPubMed
McAdam, D, Tarrow, S and Tilly, C (2001) Dynamics of Contention Cambridge. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Mele, V (2010) Government innovation policy in Italy (1993–2002). Understanding the invention and persistence of a public management reform. Governance 23, 251–276.CrossRefGoogle Scholar
Mele, V and Ongaro, E (2014) Public sector reform in a context of political instability: Italy 1992–2007. International Public Management Journal 17, 111–142.CrossRefGoogle Scholar
Melloni, E, Pesce, F and Vasilescu, C (2016) Are social mechanisms usable and useful in evaluation research? Evaluation 22, 209–227.CrossRefGoogle Scholar
Merton, RK (1968) Social Theory and Social Structure, enlarged ed. New York: The Free Press.Google Scholar
Nolte, E, Knai, C and Saltman, RB (2014) Assessing chronic disease management in European health systems. European Observatory on Health Systems and Policies.Google Scholar
Ongaro, E (2006) The dynamics of devolution processes in legalistic countries: organisational change in the Italian public sector. Public Administration 84, 737–770.CrossRefGoogle Scholar
Ongaro, E (2013a) The administrative reform trajectory of the European commission in comparative perspective: historical New institutionalism in compound systems. Public Policy and Administration 28, 346–363.CrossRefGoogle Scholar
Ongaro, E (2013b) Explaining contextual influences on the dynamics of public management reforms: Reflections on some ways forward. In Pollitt, C (ed.), Context in Public Policy and Management: The Missing Link? Cheltenham, UK and Northampton, MA: Edward Elgar, pp. 192–207.Google Scholar
Ongaro, E (2019) Advancing the theory and practice of public sector reform through the analysis of social mechanisms. In Capano, G, Howlett, M, Ramesh, M and Virani, A (eds), Making Policies Work: First and Second Order Mechanisms in Policy Design. Cheltenham, UK and Northampton, MA: Edward Elgar.Google Scholar
Ongaro, E (2020) Philosophy and Public Administration: An Introduction, 2nd ed. Cheltenham, UK and Northampton, MA: Elgar.CrossRefGoogle Scholar
Ongaro, E, Ferré, F and Fattore, G (2015) The fiscal crisis in the health sector: patterns of cutback management across Europe. Health Policy 119, 954–963.CrossRefGoogle ScholarPubMed
Pettigrew, AM (1990) Longitudinal field research on change: theory and practice. Organization Science 1, 267–292.CrossRefGoogle Scholar
Pollitt, C (ed.) (2013) Context in Public Policy and Management: The Missing Link? Cheltenham, UK and Northampton, MA: Edward Elgar.CrossRefGoogle Scholar
Stinchcombe, A (1991) The conditions of fruitfulness of theorizing about mechanisms in social science. Philosophy of the Social Sciences 21, 367–388.CrossRefGoogle Scholar
Van de Ven, AH and Poole, MS (1990) Explaining development and change in organizations. Academy of Management Review 20, 510–540.CrossRefGoogle Scholar
Wyke, A (2011) The future of healthcare in Europe. A report from the economist intelligence unit. The Economist, 35–48.Google Scholar
Yin, RK (2018) Case Study Research and Applications: Design and Methods, 5th edn. London: Sage.Google Scholar