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The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases.

Authors
  • Rocco, Philip1
  • Kelly, Andrew S2
  • Béland, Daniel3
  • Kinane, Michael4
  • 1 Marquette University.
  • 2 Johns Hopkins University.
  • 3 University of Saskatchewan.
  • 4 University of California, Berkeley.
Type
Published Article
Journal
Journal of health politics, policy and law
Publication Date
Feb 01, 2017
Volume
42
Issue
1
Pages
5–52
Identifiers
DOI: 10.1215/03616878-3702746
PMID: 27729442
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform. Copyright © 2017 by Duke University Press.

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