Health policy transfer from the US to the UK: understanding the rationale of politicians and policy-makers

Stem, Anthony D (2025). Health policy transfer from the US to the UK: understanding the rationale of politicians and policy-makers. University of Birmingham. Ph.D.

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Abstract

Since the mid-1990s ‘policy transfer’ emerged and developed as an important construct in public policy analysis. In 2000, Dolowitz & Marsh (D&M) developed a path-breaking theoretical framework largely, though not entirely state-centric, for policy transfer. In 2010, Sable & Zeitlin (S&Z) developed experimentalist governance, evolved from a theory of policy learning in the European Union, which took the theory of policy transfer to a novel level of policy-making in the shadow of hierarchy. Both are employed in this study as theoretical lenses to view health policy transfer from the USA to England. In the domain of health care, anecdotally, English health policy stakeholders from various backgrounds/interests undertake initiatives to acquire policy ideas, learning, and ultimately policy or programme transfer from United States’ health care institutions, practitioners, and innovators. The question of whether the US predominates in health policy transfer to England among all other countries and, if so, why, has not been systematically explored. This qualitative study explored these questions with one-on-one indepth semi-structured interviews of elite English health policy stakeholders: NHS executives or managers; politicians or former politicians; political advisors; think tank officials; academics; and clinicians. A ‘passive consciousness,’ tantamount to acceptance, of the US as a privileged source of health policy or programme innovation was apparent. However, data collected in response to research questions demonstrated universal rejection of any aspect of the US at a system level. There was, however, enthusiastic interest in acquiring specific tools and techniques from the US. It was clear, however, that policy transfer in England was not a coordinated function. The D&M and S&Z theoretical frameworks were validated and, in combination, offer new insights. Policy transfer has important implications for cost, quality, access, equity, and system improvement, and can change the character and values of a system. In light of these findings, this study aims to provide insights for English health policy stakeholders to improve the oversight, steering, or management of policy transfer.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

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