Remaking Policy: Scale, Pace, and Political Strategy in Health Care Reform

By Carolyn Hughes Tuohy

© 2018

One of the most persistent puzzles in comparative public policy concerns the conditions under which discontinuous policy change occurs. In Remaking Policy, Carolyn Hughes Tuohy advances an ambitious new approach to understanding the relationship between political context and policy change.

Focusing on health care policy, Tuohy argues for a more nuanced conception of the dynamics of policy change, one that makes two key distinctions regarding the opportunities for change and the magnitude of such changes. Four possible strategies emerge: large-scale and fast-paced ("big bang"), large-scale and slow-paced ("blueprint"), small-scale and rapid ("mosaic"), and small-scale and gradual ("incremental"). As Tuohy demonstrates, these strategies are determined not by political and institutional conditions themselves, but by the ways in which political actors, individually and collectively, read those conditions to assess their prospects for success in the present and over time.

Drawing on interviews as well as primary and secondary accounts of ten health policy cases over seven decades (1945—2015) in the US, UK, the Netherlands, and Canada, Remaking Policy represents a major advance in understanding the scale and pace of change in health policy and beyond.

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  • Division: Scholarly Publishing
  • World Rights
  • Page Count: 688 pages
  • Dimensions: 6.0in x 1.4in x 9.0in
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Quick Overview

In Remaking Policy, Carolyn Hughes Tuohy advances an ambitious new approach to understanding the relationship between political context and policy change.

Remaking Policy: Scale, Pace, and Political Strategy in Health Care Reform

By Carolyn Hughes Tuohy

© 2018

One of the most persistent puzzles in comparative public policy concerns the conditions under which discontinuous policy change occurs. In Remaking Policy, Carolyn Hughes Tuohy advances an ambitious new approach to understanding the relationship between political context and policy change.

Focusing on health care policy, Tuohy argues for a more nuanced conception of the dynamics of policy change, one that makes two key distinctions regarding the opportunities for change and the magnitude of such changes. Four possible strategies emerge: large-scale and fast-paced ("big bang"), large-scale and slow-paced ("blueprint"), small-scale and rapid ("mosaic"), and small-scale and gradual ("incremental"). As Tuohy demonstrates, these strategies are determined not by political and institutional conditions themselves, but by the ways in which political actors, individually and collectively, read those conditions to assess their prospects for success in the present and over time.

Drawing on interviews as well as primary and secondary accounts of ten health policy cases over seven decades (1945—2015) in the US, UK, the Netherlands, and Canada, Remaking Policy represents a major advance in understanding the scale and pace of change in health policy and beyond.

Continue Reading Read Less

Product Details

  • Division: Scholarly Publishing
  • World Rights
  • Page Count: 688 pages
  • Dimensions: 6.0in x 1.4in x 9.0in
  • Reviews

    "Remaking Policy is, quite simply, one of the most significant and innovative works on the comparative politics of public policy of the last thirty years. Central to its contribution is a novel analysis of temporal features of policy change. As Tuohy points out, policy changes differ not merely in what they seek to do, but also in how rapidly they seek to do it: while some reforms are enacted in a single burst, others unfold gradually over long periods of time. Drawing on a wealth of comparative-historical evidence from four advanced democracies, she shows how different configurations of political conditions generate differently paced reforms and demonstrates that the speed of policy change has major implications for its outcomes. Painstakingly researched and elegantly crafted, Remaking Policy is sure to leave an enduring mark on historical-institutionalist debates about the causes and character of policy and institutional development."


    Alan M. Jacobs, Department of Political Science, University of British Columbia

    "Remaking Policy gives scholarly communities, including political scientists interested in theories of change in the welfare state, and scholars of comparative health policy and politics a new interpretation of political dynamics and a sophisticated set of case studies."


    Joseph White, Luxenberg Family Professor of Public Policy, Case Western Reserve University
  • Author Information

    Carolyn Tuohy is a professor emeritus of political science and founding fellow in the School of Public Policy and Governance at the University of Toronto.
  • Table of contents

    Part I: Overview and theory

    Chapter One: Overview
    Chapter Two: Defining the Scale and Pace of Policy Change

    Part II: The Founding and Evolution of the Health care State to the 1980s

    Chapter 3: The Establishment and Evolution of the British and American Health Care States to the 1980s
    Chapter Four: The Establishment and Evolution of the Dutch and Canadian Health Care States to the 1980s

    Part III: remaking the Health Care State at the Millennium, 1987-2015

    Chapter Five: British and American Health Care Reform Strategies, Late 1980s to Late 2000s
    Chapter Six: The American Mosaic 2009-2014 – Return to Unfinished Business
    Chapter Seven: The English Mosaic 2010-2014 - Evolution in Revolutionary Clothing
    Chapter Eight: The Dutch Blueprint 1987-2006
    Chapter Nine: Canadian Incrementalism Reinforced, 1995-2004

    Part IV: institutional entrepreneurs and the course of Market-oriented reform

    Chapter Ten: Institutional Entrepreneurs and Market-Based Reform: Theory and Experience in Britain, the Netherlands and the US

    Part v: Conclusion

    Chapter Eleven: Understanding Policy Change

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