Introduction to Special Issue on Political Economy of Health Financing Reform

Abstract

CONTENTS References This special issue of Health Systems & Reform, sponsored by the World Health Organization (WHO), places political economy at the center of health financing reform. The motivation for the World Health Organization’s program of work in this area is to make political economy analysis an integral part of reform design, adoption, and implementation processes to improve the performance and equity of health systems. The articles show the importance of political economy factors in influencing the outcomes of health financing reform. They also highlight how political economy analysis can be a powerful lever to improve the chances that technically sound policy proposals are adopted and implemented. This special issue provides guidance to reformers—those who lead health policy development and implementation—on how to use political economy analysis to advance health financing reform in support of Universal Health Coverage. The authors in this project have first-hand experience with health reform in a variety of ministerial, multilateral, and academic positions. The articles focus on how reform teams can maneuver within their own national contexts to navigate complex political economy dynamics in ways that enable reform. Each example stresses that good ideas and evidence alone often do not produce desired results. Reformers need political skills to convert reform plans into implemented policy. Although the impetus for health financing reform can come from different sources, often policymakers and government must lead the charge for change. Typically, this is the case with health financing reform, which inherently has redistributive implications, between beneficiary groups, rich and poor, healthy and sick, young and old, and powerful and powerless. As highlighted in the World Development Report 2004, the push for policy change can come directly from citizens collectively organized to demand altered benefits (i.e., “people”). In the health sector, citizens can sometimes influence “providers,” but generally they cannot affect