Reforms in health policy during the Greek bailout: what makes reform successful and why?

Abstract

Despite consecutive MoUs (2010, 2012, 2015), Greek health reforms have been slow-moving with some successes and failures. Why did some reforms succeed while others failed to be implemented? Using the Multiple Streams Framework (MSF), this working paper presents evidence collected from interviews with health policy-related elites and stakeholders in Greece and traces the process of implementation to identify sticky points and configurations of pro- and anti-change coalitions. We hypothesise implementation outcomes are due to three factors: the strategies and power of the main non-state coalition partner (the medical profession), the size of resources needed for successful implementation, and 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 (mainly unsuccessful implementation). The working paper concludes with implications about policy implementation and practical lessons for policymakers considering possible implementation obstacles