Department of Health Systems Governance and Financing, World Health Organization , Geneva , Switzerland.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Boston , USA.
Health Syst Reform. 2019;5(3):183-194. doi: 10.1080/23288604.2019.1633874. Epub 2019 Aug 1.
Health financing reform is an inherently political process that alters the distribution of entitlements, responsibilities and resources across the health sector and beyond. As a result, changes in health financing policy affect a range of stakeholders and institutions in ways that can create political obstacles and tensions. As countries pursue health financing policies that support progress towards Universal Health Coverage, the analysis and management of these political concerns must be incorporated in reform processes. This article proposes an approach to political economy analysis to help policy makers develop more effective strategies for managing political challenges that arise in reform. Political economy analysis is used to assess the power and position of key political actors, as a way to develop strategies to change the political feasibility of desired reforms. Applying this approach to recent health financing reforms in Turkey and Mexico shows the importance of political economy factors in determining policy trajectories. In both cases, reform policies are analyzed according to the roles and positions of major categories of influential stakeholders: interest group politics, bureaucratic politics, budget politics, leadership politics, beneficiary politics, and external actor politics. The strategic responses to each political economy factor stress the connectedness of technical and political processes. Applying the approach to the two cases of Turkey and Mexico retrospectively shows its relevance for understanding reform experiences and its potential for helping decision makers manage reform processes prospectively. Moving forward, explicit political economy analysis can become an integral component of health financing reform processes to inform strategic responses and policy sequencing.
卫生筹资改革是一个内在的政治过程，它改变了卫生部门乃至更广泛领域的权益、责任和资源的分配。因此，卫生筹资政策的变化会以各种方式影响到一系列利益攸关方和机构，从而造成政治障碍和紧张局势。随着各国推行支持全民健康覆盖目标的卫生筹资政策，在改革进程中必须纳入对这些政治问题的分析和管理。本文提出了一种政治经济学分析方法，以帮助决策者制定更有效的战略，应对改革中出现的政治挑战。政治经济学分析用于评估关键政治行为体的权力和地位，以此制定改变所需改革政治可行性的战略。将这一方法应用于土耳其和墨西哥最近的卫生筹资改革，表明政治经济学因素在决定政策轨迹方面的重要性。在这两个案例中，根据有影响力的主要利益相关者群体的角色和地位来分析改革政策：利益集团政治、官僚政治、预算政治、领导政治、受益方政治和外部行为体政治。对每个政治经济学因素的战略应对强调了技术和政治进程的关联性。将该方法应用于土耳其和墨西哥的两个案例进行回顾性分析，表明其对理解改革经验具有相关性，并有可能帮助决策者前瞻性地管理改革进程。展望未来，明确的政治经济学分析可以成为卫生筹资改革过程的一个组成部分，为战略应对和政策排序提供信息。
