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Policy layering has received significant scholarly attention in recent years as a means to explain and understand the outcomes of policy implementation efforts, particularly within the context of incremental change. However, little is known about how processes of policy layering and institutional legacies play out in (relatively rare) system-wide and transformative policy reforms. This article presents a critical case study of one such reform—the Australian National Disability Insurance Scheme (NDIS). In examining the implementation experiences of the NDIS, we resist the bifurcation of the study of policy dynamics into a stability versus big bang dualism by revealing that many influential and constraining factors in a layering process are common across both incremental and transformative reforms. Moreover, we find that layering is not merely an unfortunate by-product of previous institutional structures but a tool that is actively sought and used by policy makers to tackle implementation challenges that, once set in motion, can move beyond the ability of policy makers to control. [ABSTRACT FROM AUTHOR]

Background: Despite decades of evidence gathering and calls for action, few countries have systematically attenuated health inequities (HI) through action on the social determinants of health (SDH). This is at least partly because doing so presents a significant political and policy challenge. This paper explores this challenge through a review of the empirical literature, asking: what factors have enabled and constrained the inclusion of the social determinants of health inequities (SDHI) in government policy agendas? Methods: A narrative review method was adopted involving three steps: first, drawing upon political science theories on agenda-setting, an integrated theoretical framework was developed to guide the review; second, a systematic search of scholarly databases for relevant literature; and third, qualitative analysis of the data and thematic synthesis of the results. Studies were included if they were empirical, met specified quality criteria, and identified factors that enabled or constrained the inclusion of the SDHI in government policy agendas. Results: A total of 48 studies were included in the final synthesis, with studies spanning a number of country-contexts and jurisdictional settings, and employing a diversity of theoretical frameworks. Influential factors included the ways in which the SDHI were framed in public, media and political discourse; emerging data and evidence describing health inequalities; limited supporting evidence and misalignment of proposed solutions with existing policy and institutional arrangements; institutionalised norms and ideologies (ie, belief systems) that are antithetical to a SDH approach including neoliberalism, the medicalisation of health and racism; civil society mobilization; leadership; and changes in government. Conclusion: A complex set of interrelated, context-dependent and dynamic factors influence the inclusion or neglect of the SDHI in government policy agendas. It is better to think about these factors as increasing (or decreasing) the 'probability' of health equity reaching a government agenda, rather than in terms of 'necessity' or 'sufficiency.' Understanding these factors may help advocates develop strategies for generating political priority for attenuating HI in the future. [ABSTRACT FROM AUTHOR]

There has recently been a resurgence of interest in fiscal mobility among policy makers in the UK and the structure of local taxation is under review. In this context Tiebout's model of fiscal mobility continues to attract interest. The key result of Tiebout's seminal paper on local public goods is well-known, but the extent to which differences in the tax-service bundle available in different localities influences residential mobility and location in practice continues to be debated. This paper revisits the issue of fiscal mobility to examine two issues. First, it considers the idea of fiscal mobility in the light of the residential mobility literature. Second, it discusses how well the idea travels and, in particular, examines the way in which the institutions and processes of local government shape the opportunities for fiscal mobility. The paper suggests that the relevance of the Tiebout model to the British, or the more generally a non-US, context has yet to be demonstrated. We also review a number of epistemological and methodological issues which, while acknowledged in the literature, have not been explored quite as extensively as they might have been. Finally, we suggest that the trajectory of the Tiebout debate raises some fundamental issues related to the philosophy of social science that warrant further investigation. We propose that approaching the debate from the perspective of a Lakatosian scientific research programme may be one potentially fruitful line of enquiry. [ABSTRACT FROM AUTHOR]

The general practitioner (GP) fundholding scheme was introduced as part of the Conservative governments 1991 National Health Service reforms and abolished by the Labour government in 1998. This paper contends that the scheme was introduced and abolished without policy-makers having any valid evidence of its effects. In particular, it focuses on the salient features of the decision to abolish. These were: (a) that it was not based on evidence; (b) that it came relatively soon after the introduction of the scheme; and (c) the GP fundholding scheme was voluntary and increasing numbers of GPs were being recruited. The overtly political nature of the introduction of GP fundholding is already well documented and is important in understanding the lack of evidence involved in the development of the fundholding scheme.