Elites and Agency in Institutional Change: The Case of Health Care Reform

Over the last decades, health care reform has been a central concern of economic policy makers around the globe. It is therefore a particularly interesting example for the application, and further development, of theoretical approaches to institutional change. Based on a brief overview of the literature concerned with such applications, the paper shows that a differentiated analysis of agency in health care reform, and in particular elite decision making and its determinants, is relatively underdeveloped compared to different strands of more structure-oriented approaches. Using examples from the comparative literature, some avenues are outlined along which such an analysis could proceed.