Complementarity and Institutional Change: How Useful a Concept?

The concept of institutional complementarity – i.e. the idea that the co-existence of two or more institutions enhances the functioning of each – is increasingly used to explain why institutions are resistant to change and why introducing new institutions into a system often leads to unintended consequences or failure to achieve the intended objective. While the concept is appealing and intuitive, in reality its utility for explaining change is less than straightforward. This paper utilizes examples from comparative political economy to, first, unpack and delineate the concept and address the issue of how to measure the strength or ‘binding force’ of complementarities. Second, it assesses the utility of the concept for explaining institutional change. It is suggested that one’s view of the methods and utility of measuring complementarity will hinge importantly on one’s general theory of institutions and institutional change. In the end, while institutional complementarities are significant, assessing their causal effect on institutional change is difficult and ambiguous in most instances. A better understanding requires that we embed complementarities within a more general theory of institutional change which takes a broader view of the ways in which institutions interconnect and change.Das Konzept der institutionellen Komplementarität – d.h. die Idee, dass zwei oder mehr Institutionen sich gegenseitig stützen und ihre Funktionsfähigkeit erhöhen – gilt mehr und mehr als Erklärung dafür, dass Institutionen gegen Veränderungen resistent sind und das Einführen neuer Institutionen in ein bestehendes System oft unerwartete Konsequenzen oder nicht darin erfolgreich sind, das gewünschte Ziel zu erreichen. Obwohl das Konzept attraktiv und intuitiv ist, ist sein Erklärungsnutzen nicht offensichtlich. In diesem Aufsatz werden Beispiele aus der vergleichenden politischen Ökonomie verwendet, um zunächst den Inhalt des Konzeptes zu umschreiben und die Frage zu stellen, wie die Stärke bzw. „Bindungskraft“ von Komplementaritäten zu messen sind. Dann bewertet er den Nutzen des Konzeptes zur Erklärung von institutionellem Wandel. Dabei ist darauf hinzuweisen, dass es stark vom Hintergrund des Betrachters, seiner allgemeinen Theorie von Institutionen und institutionellem Wandel, abhängt, welchen Blickwinkel er in Bezug auf die Einschätzung der Methoden und des Nutzen der Komplementaritätsmessung einnimmt. Abschließend stellt sich heraus, dass institutionelle Komplementaritäten wichtig sind, es aber in den meisten Fällen schwierig und unklar bleibt, ihren kausalen Effekt auf institutionellen Wandel zu bewerten. Zum besseren Verständnis ist es notwendig, dass das Konzept der Komplementaritäten in eine allgemeine Theorie des institutionellen Wandels eingebettet wird, die eine breitere Sicht über die Art und Weise zulässt, wie Institutionen untereinander verbunden sind und sich verändern

How Many Varieties of Capitalism? Comparing the Comparative Institutional Analyses of Capitalist Diversity

This essay reviews the development of approaches within the comparative capitalisms (CC) literature and points to three theoretical innovations which, taken together, define and distinguish these approaches as a group. First, national economies are characterized by distinct institutional configurations that generate a particular systemic 'logic' of economic action. Second, the CC literature suggests a theory of comparative institutional advantage in which different institutional arrangements have distinct strengths and weaknesses for different kinds of economic activity. Third, the literature has been interpreted to imply a theory of institutional path dependence. Behind these unifying characteristics of the literature, however, lie a variety of analytical frameworks and typologies of capitalism. This paper reviews and compares these different frameworks by highlighting the fundamental distinctions among them and drawing out their respective contributions and limitations in explaining economic performance and institutional dynamics. The paper concludes that the way forward for this literature lies in developing a more dynamic view of individual institutions, the linkages between domains, and the role of politics and power.In diesem Discussion Paper werden Ansätze der Comparative-Capitalism-Diskussion vorgestellt. Sie haben drei theoretische Innovationen gemein. Erstens: Nationale Ökonomien werden durch institutionelle Konfigurationen geprägt, die auf jeweils eigene "systemische Logiken" wirtschaftlichen Handelns hinwirken. Zweitens: Die Comparative-Capitalism-Literatur beinhaltet eine Theorie der komparativen institutionellen Vorteile, der zufolge institutionellen Konfigurationen spezifische Wettbewerbsvorteile zugeordnet werden können. Zudem, drittens, beinhaltet die Comparative-Capitalism-Literatur auch eine implizite Theorie der Pfadabhängigkeit. Trotz dieser Gemeinsamkeiten unterscheiden sich die Ansätze hinsichtlich analytischer Zugriffe und Vorschläge zur Typologisierung nationaler Kapitalismen. Beim Vergleich dieser Ansätze werden besonders deren Stärken und Schwächen bei der Analyse wirtschaftlicher Performanz und institutioneller Entwicklungsdynamiken hervorgehoben. Der Aufsatz kommt zu dem Schluss, dass die Comparative-Capitalism-Literatur in dreierlei Hinsicht der Weiterentwicklung bedarf: hinsichtlich einer dynamischeren Modellierung von Institutionen, einem besseren Verständnis der Interaktion institutioneller Domänen und der Berücksichtigung von Macht und Politik in der Analyse von Produktionsregimen

Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial.

BACKGROUND Treatment of venous thromboembolism in children is based on data obtained in adults with little direct documentation of its efficacy and safety in children. The aim of our study was to compare the efficacy and safety of rivaroxaban versus standard anticoagulants in children with venous thromboembolism. METHODS In a multicentre, parallel-group, open-label, randomised study, children (aged 0-17 years) attending 107 paediatric hospitals in 28 countries with documented acute venous thromboembolism who had started heparinisation were assigned (2:1) to bodyweight-adjusted rivaroxaban (tablets or suspension) in a 20-mg equivalent dose or standard anticoagulants (heparin or switched to vitamin K antagonist). Randomisation was stratified by age and venous thromboembolism site. The main treatment period was 3 months (1 month in children <2 years of age with catheter-related venous thromboembolism). The primary efficacy outcome, symptomatic recurrent venous thromboembolism (assessed by intention-to-treat), and the principal safety outcome, major or clinically relevant non-major bleeding (assessed in participants who received ≥1 dose), were centrally assessed by investigators who were unaware of treatment assignment. Repeat imaging was obtained at the end of the main treatment period and compared with baseline imaging tests. This trial is registered with ClinicalTrials.gov, number NCT02234843 and has been completed. FINDINGS From Nov 14, 2014, to Sept 28, 2018, 500 (96%) of the 520 children screened for eligibility were enrolled. After a median follow-up of 91 days (IQR 87-95) in children who had a study treatment period of 3 months (n=463) and 31 days (IQR 29-35) in children who had a study treatment period of 1 month (n=37), symptomatic recurrent venous thromboembolism occurred in four (1%) of 335 children receiving rivaroxaban and five (3%) of 165 receiving standard anticoagulants (hazard ratio [HR] 0·40, 95% CI 0·11-1·41). Repeat imaging showed an improved effect of rivaroxaban on thrombotic burden as compared with standard anticoagulants (p=0·012). Major or clinically relevant non-major bleeding in participants who received ≥1 dose occurred in ten (3%) of 329 children (all non-major) receiving rivaroxaban and in three (2%) of 162 children (two major and one non-major) receiving standard anticoagulants (HR 1·58, 95% CI 0·51-6·27). Absolute and relative efficacy and safety estimates of rivaroxaban versus standard anticoagulation estimates were similar to those in rivaroxaban studies in adults. There were no treatment-related deaths. INTERPRETATION In children with acute venous thromboembolism, treatment with rivaroxaban resulted in a similarly low recurrence risk and reduced thrombotic burden without increased bleeding, as compared with standard anticoagulants. FUNDING Bayer AG and Janssen Research & Development