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The objective of the paper is to assess the usefulness of conceptions of different modes of governance for understanding policy outcomes by studying the experience with hierarchical and non-hierarchical governance modes in the health care sector in China, India, and Thailand. The paper shows their experience with non-hierarchical modes to have been largely disappointing and that all three, but especially Thailand, are in the process of reverting to a more hierarchical mode of service delivery. The conclusion from this study is that non-hierarchical governance is not a substitute for or an improvement upon hierarchical governance in health care due to the many market and government failures that afflict the sector and affect the ability of different governance modes to function effectively. The hierarchical mode of government is also imperfect but less so than the alternatives in delivering health care. [ABSTRACT FROM AUTHOR]

The government of Hong Kong has been trying to reform the territory's health care financing system since the early 1990s and is finally on the verge of succeeding. The objective of this paper is to assess the reform efforts and explain the causes of repeated failures and eventual success. It will argue that the government's fortunes changed only after it abandoned the core reform goal and decided to pursue peripheral objectives. It will explain the abandonment with reference to the peculiar political system in Hong Kong that makes it difficult for the government to adopt substantial policy reforms in the face of even moderate opposition. The reason for the government's policy incapacity is the existence of liberalism in a non-democratic setting, which allows the government to neither suppress opposition nor mobilize popular support. This has been illustratively evident in its health care reforms when its proposals to improve the system's fiscal sustainability invariably met an early death because they imposed costs on employers, the population or both. The current proposal has fared better not only because it addresses a simpler peripheral problem but also because it offends almost no one and pleases many among the powerful. [ABSTRACT FROM AUTHOR]