CEU Electronic Theses and Dissertations, 2016
| Author | Löblová, Olga |
|---|---|
| Title | Halted Diffusion: Epistemic Communities and the Non-Adoption of Health Technology Assessment Agencies in Central and Eastern Europe |
| Summary | International policy diffusion is often portrayed as a quasi-automatic process in which fashionable policy options spread from one country to another relatively unconstrained. This dissertation challenges this prevalent assumption and argues that variables mediating diffusion matter – not only as enablers of the process but also as potential hinderers. It studies the mediating role of domestic epistemic communities (groups of experts whose knowledge leads them to pursue a common policy goal) on the adoption of international policy trends. It finds that the central scope condition for the adoption of the communities’ preferred policies is decision-makers’ demand for their input. This is in contrast to existing scholarship, which assumes that decision-makers necessarily follow epistemic communities’ advice when facing complexity and uncertainty. These findings result from a fresh look at the universe of cases of policy diffusion and epistemic communities’ influence that includes negative cases, often ignored in literature and policy debates, in addition to the well-analyzed positive ones. This dissertation studies the diffusion (and non-diffusion) of health technology assessment (HTA) agencies. HTA agencies are public bodies that evaluate available evidence on the medical, economic, ethical, legal, social and other aspects of health interventions – drugs, medical devices, diagnostic procedures, surgical interventions and the like. In a textbook case of policy diffusion, they have since the late 1980s spread from a handful of early adopters to most countries in Western Europe (leading to a “success bias” of the practitioner literature on HTA similar to the one prevalent in diffusion theory), but not to most Central and Eastern European countries. The dissertation is composed of three independent papers which each examine the reasons for the halted diffusion of HTA agencies. Their findings are based on a set of 77 interviews with key health policy actors and document analysis. Paper I establishes a chronological taxonomy of HTA agencies in the European Union. It finds structural variables unsatisfactory to explain the pattern of their diffusion, and proposes an alternative explanatory model focusing on the role of actors, more specifically domestic epistemic communities. Paper II tests this model empirically based on the Polish and Czech cases: Poland established an HTA agency in 2005, while the Czech Republic does not have one, despite a debate in 2011-2013. It finds a clear influence of the domestic epistemic community in both countries, which was, however, in the Czech Republic, moderated by a lack of policy-makers’ demand for expert input. Paper III studies health policy actors’ interests and policy positions regarding delegation of pricing and reimbursement competences to an HTA body in the Czech case, and confirms the key place of policy-makers’ demand. It concludes that interests of actors (including the epistemic community of “aspiring agents”) are close to irrelevant, as long as the principals do not perceive the need for expertise. Concluding remarks of the dissertation note the near non-existence of sound policy evaluation of HTA and suggest that policy-makers’ willingness to listen to HTA epistemic communities may have more to do with their modernizing ambitions than with HTA’s unclear achievements in improving the quality, equity or sustainability of health systems. |
| Supervisor | Nikolai Sitter |
| Department | School of Public Policy PhD |
| Full text | https://www.etd.ceu.edu/2016/loblova_olga.pdf |
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