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Divergent spender: State-societal and meso-organisational mechanisms in the containment of public spending on pharmaceuticals in a liberal capitalist democracy
Sociology of Health & Illness ( IF 2.7 ) Pub Date : 2021-07-15 , DOI: 10.1111/1467-9566.13343
Ben Main 1 , Piotr Ozieranski 2
Affiliation  

For two decades, New Zealand has been placed consistently at the foot of OECD rankings for state expenditure on pharmaceuticals. In this article, we explore New Zealand's containment of pharmaceutical spending as a ‘divergent’ case of pharmaceutical policy in a liberal democracy. To elucidate the likely institutional mechanisms and interests behind this phenomenon, we conducted a case study of New Zealand's drug reimbursement policy. In doing so, we derived sensitising concepts from major accounts of pharmaceutical policymaking (Corporate Bias Theories and Reputational Theory) and theories of the western state (Historical Institutionalism and Corporate Domination Theory). Drawing on 28 expert interviews and documentary analysis, we identified three main mechanisms of spending containment. First, New Zealand's state bureaucracy use pricing strategies that rely on a spending containment strategy coordinated by bureaucratic managers. Second, these managers shape the policy preferences of expert committees involved in scientific drug assessment. Third, on a meta-level, conditions for spending containment are enabled by the judicial-legislative arena. As such, we find support for Historical Institutionalism and Reputational Theory and more limited support for Corporate Bias Theory and Corporate Domination Theory. Our explanation posits further conceptual linkages between the macro/societal and meso-organisational theoretical levels.

中文翻译:

不同的支出者:在自由资本主义民主国家遏制公共药品支出的国家社会和中间组织机制

两十年来,新西兰一直在经合组织国家药品支出排名中名列前茅。在本文中,我们将新西兰对医药支出的控制视为自由民主国家医药政策的“不同”案例。为了阐明这种现象背后可能的制度机制和利益,我们对新西兰的药物报销政策进行了案例研究。在这样做的过程中,我们从制药政策制定(公司偏见理论和声誉理论)和西方国家理论(历史制度主义和公司支配理论)的主要解释中得出了敏感概念。通过 28 位专家访谈和文献分析,我们确定了三个主要的支出控制机制。第一,新西兰 国家官僚机构使用的定价策略依赖于由官僚管理者协调的支出控制策略。其次,这些管理者塑造了参与科学药物评估的专家委员会的政策偏好。第三,在元层面上,限制支出的条件是由司法立法领域提供的。因此,我们发现对历史制度主义和声誉理论的支持以及对公司偏见理论和公司支配理论的支持更为有限。我们的解释在宏观/社会和中观组织理论层面之间建立了进一步的概念联系。在元层面上,限制支出的条件是由司法立法领域实现的。因此,我们发现对历史制度主义和声誉理论的支持以及对公司偏见理论和公司支配理论的支持更为有限。我们的解释在宏观/社会和中观组织理论层面之间建立了进一步的概念联系。在元层面上,限制支出的条件是由司法立法领域实现的。因此,我们发现对历史制度主义和声誉理论的支持以及对公司偏见理论和公司支配理论的支持更为有限。我们的解释在宏观/社会和中观组织理论层面之间建立了进一步的概念联系。
更新日期:2021-08-11
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