Effective Strategies for Polycentric Governance in Health Care Systems
Explore the institutional repertoire required for sustainable polycentric governance in the U.S. health care system, focusing on shared access, production, and coordination. Discover micro-level extensions and macro-level elaborations of the ADICO framework for better policy evaluation.
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Understanding the Institutional Repertoire Required for Effective and Sustainable Polycentric Governance Michael D. McGinnis Discussion paper prepared for Working Group on Institutions, Behavior and Policy Outcomes Workshop: Advancing Theoretical and Methodological Approaches for the Study of Compliance School of Public Affairs, San Diego State University, June 4-5, 2015
From My Research on the U.S. Health Care System See the system as it is: Subsystems of health care, health insurance, public health, and healthy behavior Built by entrepreneurial innovation: private, public, and voluntary programs of many kinds Proto-polycentric: Many inter-related forms of shared access to and/or shared consumption of resources, and shared production, financing, rule-making, monitoring, and sanctioning Fragmented and institutionally diverse, but insufficient coordination (of many kinds) to be fully polycentric How can we turn this fragmentation to better purposes? How might research based on the ADICO framework help?
Micro-Level Extensions of ADICO Other forms of institutional statements From shared strategies to shared conceptualizations, individual strategies, heuristics, and coalitions From norms and rules to roles, positions, and formal organizations and their agents Institutional repertoire Collection of all institutional forms for individual or collective action that are available for use by that group Linkages among institutional statements From OR ELSE to roles and other rules and norms For policy evaluation or comparative studies follow ramifications of changes in particular rules, norms, etc.
Macro-Level Elaborations of ADICO ADICO aggregate: networked structure? How related to concepts of regime or policy sector? Growth/decline of institutional repertoire or ADICO aggregate? ADICO embedded within decision units or centers of authority as configuration of people, resources, institutions What else is needed for a polycentric order? Need more than multiplicity of overlapping decision units: overarching system of rules (institutional repertoire) and effective levels of coordination Efficiencies of scale, and third order collective action problem Relationship to IAD framework Commons, property, jurisdictions as decision units/action situations Apply ADICO to working components of action situation?
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