Dental Policy Lab 2 - towards paying for health in dentistry

The first Alliance for a Cavity-Free Future (ACFF)/King's College London Dental Policy Lab, held in 2017, identified the need for a review of dental payment systems in order to see progress towards achieving improvements in caries and cavities. The lack of incentivisation for preventive intervention and care has long been a barrier to progress. The second Dental Policy Lab, held in July 2018, focused on this issue with the overarching question: 'How can we create and implement acceptable prevention-based dental payment systems to achieve and maintain health outcomes?' Using a design approach and participatory research, 29 participants from five stakeholder categories developed a blueprint report that aims to serve as a framework to adapt or create remuneration systems that are compatible with evidence-based dentistry with a focus on preventive care. Aimed at policymakers and policy entrepreneurs, this blueprint provides guidance and potential solutions using several international examples. The report and accompanying infographic explored in this paper have been well received and have helped to frame discussions in several country settings, with a direct implementation which is being trialled in France in 2021.

A threat-centered theory of policy entrepreneurship

We know relatively little about the conditions that encourage people to jump into the political fray as policy entrepreneurs, advocates who devote substantial time, energy, and resources to campaigning for a policy goal. This paper aims to fill that gap by investigating the catalysts of policy entrepreneurship in municipalities across the State of New York, where between 2008 and 2012, hundreds of local jurisdictions passed measures opposing or supporting high-volume hydraulic fracturing (fracking). These local policy actions were often enthusiastically encouraged and, in some cases, vociferously opposed, by enterprising advocates. I propose a threat-centered theory of policy entrepreneurship, emphasizing the role of loss aversion in pushing actors toward advocacy. The empirical analysis shows that oppositional advocacy within a polity draws would-be policy entrepreneurs into battle.

District health network policy in Iran: the role of ideas, interests, and institutions (3i framework) in a nutshell

Background District Health Network (DHN), one of Iran’s most successful health reforms, was launched in 1985 to provide primary health care (PHC), in response to health inequities in Iran. The present study aims to use interrelated elements of the 3i framework: ideas (e.g., beliefs and values, culture, knowledge, research evidence and solutions), interests (e.g., civil servants, pressure groups, elected parties, academians and researchers, and policy entrepreneurs), and institutions (e.g., rules, precedents, and organizational, government structures, policy network, and policy legacies) to explain retrospectively how (DHN) policy in Iran, as a developing country, was initiated and formed. Methods A historical narrative approach with a case study perspective was employed to focus on the formation and framing process of DHN. For this purpose, the 3i framework was used as a guideline for data analysis. This study mainly searched and extracted secondary sources, including online news, reports, books, dissertations, and published articles in the scientific databases. Primary interviews as a supplementary source were also carried out to meet cross-validation of the data. Data were analyzed using a deductive and inductive approach. Results According to the 3i framework, the following factors contributed to the formation of DHN policy in Iran: previous national efforts (for instance Rezaieh plan) and international events aiming to provide public health services for peripheral regions; dominant social discourses and values at the beginning of the Iranian revolution such as addressing the needs of disadvantaged and marginalized groups, which were embedded in the goals of DHN policy aiming to provide basic health services for deprived people especially living in rural and remote areas. Besides, the remarkable social cohesion and solidarity among people reinforced by the Iran-Iraq war were among other factors which contributed to the formation of participatory plans such as DHN (ideas). Main policy entrepreneurs including Minister of Health, his public health deputy and two planners of DHN with similar and rich background in the public health field and sharing the same beliefs (interests) which subsequently led to creation of tight-knit policy community network between them (institutions) also accelerated the creation of DHN in Iran to great extent. Political support of parliamentary representatives (interests), and formal laws such as principles of Iran Constitution (institutions) were also influential in passing the DHN in Iran. Conclusions The 3i framework constituents would be insightful in explaining the creation of public health policies. This framework showed that the alignment of laws, structures, and interests of the main actors of the policy with the dominant ideas and beliefs in the society, opened the opportunity to form DHN in Iran.

Ideas and Aspirations

This chapter explores how, behind the change in economic policymaking, lies a change in the ideas of the elite. And behind the change in ideas was a relentless scanning of experience outside Spain, especially in Europe. The chapter documents how the technocrats that held increasing power in 1960s Spain consistently sought out new ideas about policymaking from Europe and the United States. They were deliberate policy entrepreneurs. Like their Western European peers, the technocrats considered a responsibility of the state to seek to advance progress for a wide spectrum of society. To pursue this objective, they considered it critical to increase efficiency and put great faith in technological progress. The chapter concludes that what truly stands out of the technocrats is that they were able to implement their practical agenda over a sustained period. There had been previous technocratic efforts to emulate European practices, sometimes from reformers that reached even higher levels of government. A long-term horizon allowed policies to evolve without unnecessary volatility, striking a balance between policy innovation and policy continuity.

Emerging Policy Entrepreneurs and Their Potential After the Great East Japan Earthquake

This study highlights new facts regarding the rise of local human resources during the policy decision process by reviewing policy entrepreneurs active in areas affected by the Great East Japan Earthquake. Specifically, the study reviews these stakeholders concerning the definitions and frameworks of prior research as well as the discussed development of policy entrepreneurs. A policy entrepreneur has been defined as “an energetic actor that conducts collaborative efforts within and around the government to promote policy innovation.” This study provides a comparative analysis of how the five strategies, as a requirement for establishing policy entrepreneurs, have been used to implement policy changes. Two cases are selected to confirm the extent to which they have utilized their respective strategies. The results reveal that both individuals have become active at their respective national and local levels by adopting the five strategies, despite there being differences in the extent of adoption. The recognition of the new existence of “policy entrepreneurs” could offer great support and identity to NPOs in disaster-afflicted areas. Promoting policy entrepreneurship could present a powerful message from the disaster-afflicted areas in Tohoku that could be shared with the entire nation of Japan, particularly considering recent times, when innovation has become necessary in Japan’s public domain.

Statecraft and incremental change: Explaining the success of pension reforms in the United Kingdom

How were comprehensive pension reforms in the UK successfully developed, enacted and implemented from 2002 to 2015, despite changes in government composition and the financial crisis? Why were they not subject to policy conflict, electoral competition and policy reversal? Drawing on actor-centred historical institutionalism and thirty interviews with key actors, we demonstrate the critical role played by a limited number of politicians and policy entrepreneurs and their ideas and agency. Institutional continuity with the Beveridgean policy legacies of the pension system and the United Kingdom’s `growth regime’ enabled a coalition space to open up for policy agreement. between the government and Opposition parties, and for partisan electoral competition over the reforms to be `bracketed’. The incremental and interlocking nature of the reform package reduced interest group opposition and enabled a centralisation of decision-making power. A long-term timeframe for reform cemented the formation of an elite coalition and buttressed political control. Cross-party support for the reform package, coupled with judicious phasing of the implementation of auto-enrolment and fiscal reforms, enabled it to withstand the impact of the financial crisis and the austerity that followed it, and to minimise opposition among the critical electoral constituency of older voters. The dominance of the reform process by political actors and policy entrepreneurs in the UK nonetheless came at a price, as institutional continuity and incrementalism foreclosed alternative reforms. We demonstrate the importance of political statecraft and policy entrepreneurship in the UK pensions’ reform process, but within boundaries set by its institutional context.

A policy window and a network of global and local policy entrepreneurs: The introduction of opioid substitution therapy in Belarus

Why does a regime that is predominantly characterised by conservative ideology introduce opioid substitution therapy (OST), a liberal policy? This article applies the Multiple Streams Framework (MSF) to examine the introduction of OST in Belarus. Methodologically, the research draws on qualitative content analysis of drug policy documents and reports as well as on interviews. Results show how an increased HIV prevalence among injecting drug users opened a policy window in the problem stream. The increase in HIV cases could be used by a network of global and local policy entrepreneurs to frame OST as a public health policy instead of a drug policy measure. Findings suggest that, in nondemocratic regimes, global policy entrepreneurs can play a dominant role in introducing new policy ideas. However, the sustainability of the policy change remains questionable when acquiescence by key policymakers is lacking.

Technology, Public Participation, and the American Bureaucracy

This dissertation analyzes three participatory technology assessment (pTA) projects conducted within United States federal agencies between 2014 and 2018. The field of Science and Technology Studies (STS) argues that a lack of public participation in addressing issues of science and technology in society has produced undemocratic processes of decision-making with outcomes insensitive to the daily lives of the public. There has been little work in STS, however, examining what the political pressures and administrative challenges are to improving public participation in U.S. agency decision-making processes. Following a three-essay format, this dissertation aims to fill this gap. Drawing on qualitative interviews with key personnel, and bringing STS, policy studies, and public administration scholarship into conversation, this dissertation argues for the significance of “policy entrepreneurs” who from within U.S. agencies advocate for pTA and navigate the political controls on innovative forms of participation. The first essay explores how the political culture and administrative structures of the American federal bureaucracy shape the bureaucratic contexts of public participation in science and technology decision-making. The second essay is an in-depth case study of the role political controls and policy entrepreneurs played in adopting, designing, and implementing pTA in NASA’s Asteroid Initiative. The third essay is a comparative analysis of how eight political and administrative conditions informed pTA design and implementation for NASA’s Asteroid Initiative, DOE’s consent-based nuclear waste siting program, and NOAA’s Environmental Literacy Program. The results of this dissertation highlight how important the political and administrative contexts of federal government programs are to understanding how pTA is designed and implemented in agency science and technology decision-making processes, and the key role agency policy entrepreneurs play in facilitating pTA through these political and administrative contexts. This research can aid STS scholars and practitioners better anticipate and mitigate the barriers to embedding innovative forms of public participation in U.S. federal government science and technology program design and decision-making processes.

POLICY ENTREPRENEURS DAN JARINGAN KEBIJAKAN PENGENTASAN KEMISKINAN DI ERA DESENTRALISASI

Salah satu indikator kemiskinan mainstream dalam kebijakan pengentasan kemiskinan di Indonesia adalah kondisi rumah yang ditempati oleh masyarakat. Indikator ini ditetapkan oleh Badan Pusat Statistik untuk menilai kelayakan rumah masyarakat dari bahan bangunan, syarat kesehatan dan kepemilikan. Hal tersebut menggerakan pemerintah pusat dan daerah untuk merumuskan kebijakan perbaikan dan pembangunan rumah layak huni bagi masyarakat berpenghasilan rendah. Alih-alih sebagai usaha pengentasan kemiskinan, policy entrepreneurs telah menegasikan isu arsitektur tradisional berbasis ramah lingkungan, ramah bencana dan hemat energi, sehingga program kemiskinan ini gagal terintegrasi sejak tahap agenda-setting. Penelitian ini menggunakan metode kualitatif dengan pendekatan analisis dokumen untuk mengelaborasi kondisi struktural dan jaringan kebijakan (policy network) yang menyebabkan kegagalan tersebut dan implikasinya melalui studi kasus program Perbaikan Rumah Tidak Layak Huni (Rutilahu) pada masa pemerintahan Gubernur Jawa Barat periode 2013-2018, Achmad Heriawan.