LSE Philosophy Professor Alex Voorhoeve and colleagues have published a paper on ‘Procedural fairness and the resilience of health financing reforms in Ukraine’ in Health Policy and Planning – The journal on health policy and systems research.
About the paper: In 2017, Ukraine’s Parliament passed legislation establishing a single health benefit package for the entire population called the Programme of Medical Guarantees, financed through general taxes and administered by a single national purchasing agency. This study argues that the acceptance and sustainability of these reforms could have been strengthened by making the decision-making process fairer (more open and inclusive). It suggests that three factors limited the extent of stakeholders’ participation in this process: first, a perception among reformers that fast-paced decision-making was required because there was only a short political window for much needed reforms; second, a lack of trust among reformers in the motives, representativeness, and knowledge of some stakeholders; and third, an under-appreciation of the importance of dialogic engagement with the public. The study shows how difficult it is to have an inclusive process in settings where some actors may be driven by unconstrained self-interest or lack the capacity to be representative or knowledgeable interlocutors. It suggests that investments in deliberative capital (the attitudes and behaviours that facilitate good deliberation) and in civil society capacity may help overcome this difficulty.