Reforms in health policy during the Greek bailouts: What makes reform successful and why?

In August 2018, the Greek government announced the exit from the bailout agreement – known as Memorandum of Understanding (MoU) – with international lenders and the return of Greece to normal politics. Nonetheless, the advocacy of an exit has not been accompanied by effective structural reforms to allow Greece to maintain future stability. Health policy is one of the challenging areas of reform regarding efficiency, effectiveness and social impact. Despite consecutive MoUs (2010, 2012 and 2015), health policy has been slow-moving regarding reform with some successes and failures. We explore the reasons behind the variable (full, partial and unsuccessful) implementation of reforms in health policy to identify obstacles and constraints. Despite being mandated by the MoUs, why did some health reforms succeed while others failed to be implemented?

Using the Multiple Streams Framework (MSF) of the policy process, the project collects evidence from interviews with health policy-related elites and stakeholders in Greece and traces the process of implementation to identify sticky points and configuration of pro- and anti-change coalitions. We hypothesise implementation outcomes are due to three factors:

1. The strategies and power of the main non-state coalition partner (the medical profession)
2. The size of resources needed for successful implementation
3. The ability (or not) of government to mobilise public opinion.

We examine three cases: the liberalisation of the pharmacy profession (successful implementation), family doctor reforms (partial implementation), and the referral system (unsuccessful implementation). The project concludes with implications about theories of implementation and practical lessons for policymakers in light of possible implementation obstacles.

The project’s research question is: Despite being mandated by the MoUs, why did some health reforms succeed while others failed to be implemented?

1. Map out the implementation of health policy reforms as outlined by the MoUs
2. Understand points of friction, conditions for pro-change coalition formation, stakeholder involvement in decision-making and implementation processes
3. Process-trace policy outcomes to determine conditions for success and failure as well as the impact of the reforms in the state of play.