Assessing health reform: studying tool appropriateness & critical capacities

Figures & data

Table 1. Core elements of universal coverage reforms.

	High Level Abstraction	Programme Level Operationalisation	Specific On-the Ground Measures
	Element # 1 Health Financing Reforms
Policy Ends or Aims	Goals What ideas govern policy development? Move towards societal risk-pooling to pay for healthcare expenditure	Objectives What outcome or aim does policy address? Lower out-of-pocket spending on healthcare, universal access, societal affordability	Settings What are on-the-ground requirements of the policy? Different types of risks covered
Policy Means or Tools	Instrument Logic What norms guide implementation preferences? Move from contributory to non-contributory health financing instruments	Instrument Choice What policy instruments are utilised? Change in policy instruments (e.g. using social health insurance, voluntary private insurance, etc);	Calibrations What are the ways in which the instrument is used? Change in benefit levels or number of beneficiaries or contribution rates
	Element #2 Provider Payment Reforms
Policy Ends or Aims	Goals What ideas govern policy development? Lowering growth in healthcare expenditure	Objectives What outcome or aim does policy address? Reducing moral hazard and information asymmetry associated with the physician agency	Settings What are on-the-ground requirements of the policy? Risk-adjustments
Policy Means or Tools	Instrument Logic What norms guide implementation preferences? Move from retrospective to prospective payments	Instrument Choice What policy instruments are utilised? Use of DRGs, Capitation, Performance-based pay	Calibrations What are the ways in which the instrument is used? DRGs weights, capitation rates, etc.

Source: Authors construction based on Howlett and Cashore (2009)

Table 2. Dimensions of Policy Effectiveness.

	Tool Appropriateness	Policy Capacity
Analytical	Is/are the instrument(s) capable of solving the problem?	Does the agency know which tool to use? Can the agency calibrate and use the policy tool?
Operational	Is the instrument operationally feasible?	Does the agency have accountability mechanisms, coordination mechanisms, trained bureaucracy?
Political	Is the instrument socially acceptable/politically viable to use?	Does the agency have the legitimacy/ability to reconcile political differences? Or deal with political opposition?

Source: Bali, Capano and Ramesh (forthcoming)

Figure 1. Share of total health expenditure financed through out of pocket payments.

Source: World Bank (2018)

Howlett, M., & Cashore, B. (2009). The dependent variable problem in the study of policy change: Understanding policy change as a methodological problem. Journal of Comparative Policy Analysis, 11(1), 33–46.

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Bali, AS., G. Capano, & M Ramesh. (Forthcoming). Anticipating and Designing for Policy Effectiveness. Policy & Society.

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