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Policy Design, Innovation and Diffusion: Evidence from Cantonal Public Health Policies in Switzerland

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Policy Design, Innovation and Diffusion: Evidence from Cantonal Public Health Policies in Switzerland Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2015 Policy Design, Innovation and Diffusion: Evidence from Cantonal Public Health Policies in Switzerland Stadter, Cornelia Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-117434 Dissertation Published Version Originally published at: Stadter, Cornelia. Policy Design, Innovation and Diffusion: Evidence from Cantonal Public Health Policies in Switzerland. 2015, University of Zurich, Faculty of Arts. Policy Design, Innovation and Diffusion: Evidence from Cantonal Public Health Policies in Switzerland Thesis presented to the Faculty of Arts and Social Sciences of the University of Zurich for the degree of Doctor of Philosophy by Cornelia Stadter Accepted in the fall semester 2015 on the recommendation of Prof. Dr. Thomas Widmer and Prof. Dr. Fabrizio Gilardi Zurich, 2018 Abstract What difference do the characteristics of innovative policies make? Do certain characteristics render such policies more adoptable? And do they condition the weight of other factors that explain policy innovation? Thus far, these questions have received little attention in research. In addressing them, this study focusses on characteristics that are inherent to the design of the particular policy innovation, including its designated beneficiaries, degree of intervention, complexity and implementation costs. Based on event history analyses of Swiss cantonal public health policies, it tests various hypotheses on the direct and indirect effects of policy design characteristics on the likelihood that states innovate. Its findings confirm that policy design characteristics matter for innovation decisions. Specifically, it shows that governments go by peer states’ previous adoptions of the policy at stake when deciding on complex and expensive innovative policies, but do not rely on such cues for decisions on simple and low-cost innovations. Because of certain empirical constraints that this study faces further research is called for to convey a more comprehensive picture of the impact of policy design characteristics on innovation. Zusammenfassung Welche Bedeutung haben die Merkmale innovativer Policies? Führen bestimmte Merkmale dazu, dass solche Policies eher angenommen werden? Beeinflussen sie ferner die Relevanz anderer Faktoren, die Politikinnovation erklären? Diese Fragen sind bislang wenig erforscht worden. Um sie zu beantworten, richtet diese Studie ihr Augenmerk auf Merkmale, die sich aus dem Design der jeweiligen Innovation ergeben: die Begünstigten, den Eingriffsgrad, die Komplexität und die Vollzugskosten. Auf der Grundlage von Ereignisdatenanalysen zu Public-Health Policies der Schweizer Kantone werden verschiedene Hypothesen zu den direkten und indirekten Auswirkungen von Merkmalen des Policy- Designs auf die Innovationswahrscheinlichkeit getestet. Die Ergebnisse bestätigen, dass die Merkmale des Policy-Designs einen Einfluss auf Innovationsentscheidungen haben. Konkret zeigt sich, dass sich Regierungen bei Entscheidungen über komplexe und teure innovative Policies – anders als bei Entscheidungen über Innovationen, die ein einfaches Design mit geringen Kosten verbinden – von früheren Annahmen der betreffenden Policy durch andere Staaten aus ihrem Vergleichsumfeld leiten lassen. Aufgrund bestimmter empirischer Grenzen, an die diese Studie stösst, sind weitere Untersuchungen notwendig, um ein vollständigeres Bild dazu zu vermitteln, wie sich Merkmale des Policy-Designs auf Innovation auswirken. i Contents 1 Introduction: Policy Innovation, Diffusion and the Characteristics of Innovative Policies ............. 1 2 State of the Art: Research on Policy Innovation and Diffusion ....................................................... 5 The Backbone of Current Research: The Core Concepts of Policy Innovation and Diffusion and Berry and Berry’s Unified Model ......................................................................................................... 5 Tour d’Horizon: Advances in Research on Policy Innovation and Diffusion in Federal States since the 1990s .................................................................................................................................... 8 Policy Characteristics and Types in Empirical Innovation and Diffusion Research ............... 20 Tobacco Control Policies: What Insights from Policy Innovation and Diffusion Research? .. 24 3 Theoretical Argument: Policy Design, Innovation and Diffusion .................................................. 34 Framework of Analysis and Conceptual Issues ..................................................................... 34 The Impact of Policy Characteristics on Innovation Decisions: Hypotheses ......................... 39 Specification and Measurement of Policy Design Characteristics ........................................ 42 4 The Policy Field Studied: Public Health Policy in Switzerland ....................................................... 46 Description of the Policy Field ............................................................................................... 47 Selection of Policies ............................................................................................................... 57 Specification and Measurement of Core Concepts in the Context of the Policy Field ......... 60 5 Policy Portraits: Content, Characteristics, Context and Diffusion ................................................. 70 Ban on Tobacco Billboard Advertising ................................................................................... 70 Ban on Tobacco Sales to Children and Adolescents .............................................................. 76 Alcohol Sales Restrictions ...................................................................................................... 81 Breast Cancer Screening Programmes .................................................................................. 86 Restaurant Food Nutrition Labelling ..................................................................................... 92 6 Statistical Methods and Data ........................................................................................................ 99 Event History Analysis: Logic and Application to the Present Research Endeavour ............. 99 Feeding the Models: Categories of Variables, Data Sources and Data Processing ............. 103 7 Explaining the Adoption of Individual Cantonal Public Health Policies....................................... 115 Ban on Tobacco Billboard Advertising ................................................................................. 115 Ban on Tobacco Sales to Children and Adolescents ............................................................ 120 Breast Cancer Screening Programmes ................................................................................ 122 Restaurant Food Nutrition Labelling ................................................................................... 127 Summary: The Determinants of Four Cantonal Public Health Policies ............................... 130 8 Disentangling the Effects of Policy Characteristics on Innovation and Diffusion........................ 131 Empirical Constraints to Hypothesis Testing ....................................................................... 132 Standardised Single Event Models: Evidence on the Indirect Effects of Policy Characteristics 133 Multiple Events Models: Evidence on the Direct and Indirect Effects of Policy Characteristics 135 Evidence on the Effects of Policy Characteristics: Summary and Appraisal........................ 142 9 Policy Design, Innovation and Diffusion: Conclusion .................................................................. 144 10 References ............................................................................................................................... 147 11 Appendix .................................................................................................................................. 164 ii List of Tables Table 1: Policy innovation and diffusion research on tobacco control policies .................................... 26 Table 2: Degree of intervention: dimensions and operational definitions ........................................... 43 Table 3: Complexity: dimensions and operational definitions .............................................................. 44 Table 4: Realms of federal competencies in public health and corresponding constitutional provisions ............................................................................................................................................................... 47 Table 5: Fields of cantonal activities in public health as defined by cantonal health acts .................... 50 Table 6: Cantonal department in charge of health (including public health) ....................................... 52 Table 7: Regional conferences within the Swiss Conference of the Cantonal Ministers of Public Health ............................................................................................................................................................... 56 Table 8: Types of point-source diffusion effects considered: operational definitions and expected effects .................................................................................................................................................... 68 Table 9: Ban on tobacco billboard
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