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6 - Policy Failures, Policy Learning and Institutional Change: The Case of Australian Health Insurance Policy Change

Published online by Cambridge University Press:  25 March 2021

Claire Dunlop
Affiliation:
University of Exeter
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Summary

Introduction

Although policy learning may stem from assessments of policy failure (Ingold and Monaghan, 2016), establishing such a relationship is not straightforward. As is well known, the drivers of policy change and observations of policy change are not necessarily closely linked across time; indeed, the temporal link between cause and effect may be stretched over relatively long periods in patterns of change (McCashin, 2016). The chapter seeks to introduce a temporal perspective to catalogue the institutional constraints and opportunities embedded in sequences of repeated policy failure; and the subsequent ability of reform advocates to learn how to use the opportunities presented in future reform struggles.

The first section of the chapter investigates the concept of policy failure in terms of several types, values and timings in order to assist understanding of how policy failures play out in longer sequences of policy making. The next section explores notions of policy learning in terms of the different types of failure identified. This leads into the main focus of the chapter: exploring connections between repeated assessments of policy failure, the catalysts of deinstitutionalisation and subsequent opportunities for system-wide policy learning and reform.

Selected evidence from the reform trajectory of Australian health insurance policy from the mid-1970s to late-1990s is used to explore these possible relationships. The current Australian health insurance system has its origins in a tumultuous and foundational sequence of policy change between 1972 and 1984, which settled down in the subsequent 15 years or so to leave Australia with a distinctive but important health insurance model (for example, Colombo and Tapay, 2003; Hurley, 2002); an intriguing combination of universal public health insurance with financial and regulatory support for one of the highest percentages of private health insurance cover in the Organisation for Economic Co-operation and Development (OECD).

The Australian health insurance case allows us to catalogue at least one pattern of the relationships between policy failure, deinstitutionalisation and learning. Three core analytical arguments underpin this pattern. First, policy failures create opportunities for learning at a system-wide level, following Elmore (1987), only after institutions have been eroded and exhausted by repeated failure. Second, this first claim holds in both the expert and political inquiry dimensions of policy failure.

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Publisher: Bristol University Press
Print publication year: 2020

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